MEDICARE: BRENDALIS RIOS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CG60433373	WA
2	1041C0700X	Clinical Social Worker	149022529	IL
3	1041C0700X	Clinical Social Worker	099145	IA
4	1041C0700X	Clinical Social Worker	60764675	WA

General Provider Information

NPI Number	:	1639598550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDALIS RIOS

Provider Business Mailing Address
First Line	:	PO BOX 34703
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98124-1703
Country	:	US
Telephone Number	:	206-764-3335
Fax Number	:	206-764-0489

Provider Business Practice Location Address
First Line	:	1030 MAPLE VIEW WAY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-6930
Country	:	US
Telephone Number	:	787-431-9520
Fax Number	:

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

Provider Enumeration Date	:	04/08/2014
Last Update Date	:	09/07/2023

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Directions to “ BRENDALIS RIOS ” Practice Location

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