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General NPI Number Information
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NPI Number | 1972355121
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Entity Type | Individual
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Provider Name | ALBERT VITELIO RIOS
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Gender | Male
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Dates
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Enumeration Date | 04/02/2024
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Last Update Date | 04/02/2024
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Provider Practice Location Address
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Address Line | 4141 S NOGALES ST UNIT A104
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City | WEST COVINA
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State | CA
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Zip | 91792-3057
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Country | US
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Telephone | 619-399-9906
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Fax |
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Provider Business Mailing Address
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Address Line | 1222 BOYNTON ST
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City | GLENDALE
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State | CA
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Zip | 91205-3407
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Country | US
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Telephone | 818-482-6544
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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