MEDICARE: RIZZALYNNE RIOS MIRO

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	235Z00000X	Speech-Language Pathologist	41YS00465000	NJ

General Provider Information

NPI Number	:	1558574517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RIZZALYNNE RIOS MIRO

Provider Business Mailing Address
First Line	:	528 CORMORANT DR
Second Line	:
City	:	VOORHEES
State	:	NJ
Zip	:	08043-3201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3002-D LINCOLN DRIVE WEST
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053
Country	:	US
Telephone Number	:	856-810-2555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	07/08/2007

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Directions to “ RIZZALYNNE RIOS MIRO ” Practice Location

Language	Start Address	Practice Location

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