MEDICARE: MS. MARISA DEL RIO NP

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	363L00000X	Nurse Practitioner	95023961	CA
2	363LF0000X	Family Nurse Practitioner	95023961	CA

General Provider Information

NPI Number	:	1801593421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARISA DEL RIO NP

Provider Business Mailing Address
First Line	:	FILE 57326
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90074-7326
Country	:	US
Telephone Number	:	800-926-8273
Fax Number	:

Provider Business Practice Location Address
First Line	:	4510 EXECUTIVE DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3021
Country	:	US
Telephone Number	:	800-926-8273
Fax Number	:

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

Provider Enumeration Date	:	02/14/2023
Last Update Date	:	05/15/2026

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