MEDICARE: MARINA CORTINOVIS L. RIOS, DDS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	44770	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G93393-01	OTHER	CA	DENTI-CAL

General Provider Information

NPI Number	:	1558573337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARINA CORTINOVIS L. RIOS, DDS, INC.

Provider Business Mailing Address
First Line	:	12732 W WASHINGTON BLVD STE D
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-2378
Country	:	US
Telephone Number	:	310-827-7467
Fax Number	:	310-827-3388

Provider Business Practice Location Address
First Line	:	12732 W WASHINGTON BLVD STE D
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-2378
Country	:	US
Telephone Number	:	310-827-7467
Fax Number	:	310-827-3388

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARINA CORTINOVIS RIOS
Credential	:	DDS
Telephone Number	:	310-827-7467

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	05/21/2019

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