MEDICARE: ROBERTO RIOS VALLE JR. APRN FMP

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	363LF0000X	Family Nurse Practitioner	676242	TX

General Provider Information

NPI Number	:	1710528567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTO RIOS VALLE JR. APRN FMP

Provider Business Mailing Address
First Line	:	2115 PLEASANTON RD STE 205
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78221-1300
Country	:	US
Telephone Number	:	210-922-3627
Fax Number	:	210-922-3245

Provider Business Practice Location Address
First Line	:	11730 WEST AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-2524
Country	:	US
Telephone Number	:	210-340-8501
Fax Number	:	210-340-0129

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

Provider Enumeration Date	:	10/02/2019
Last Update Date	:	12/19/2025

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