=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942267695
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EDUARDO A. RIOS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2006
-----------------------------------------------------
Last Update Date | 07/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 32 CALLE ANTONIO LOPEZ
-----------------------------------------------------
City | TOA ALTA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-870-3760
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 902
-----------------------------------------------------
City | TOA ALTA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00954-0902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-870-3760
-----------------------------------------------------
Fax | 787-870-2735
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | EDUARDO ALFONSO RIOS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-870-3760
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 0634
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------