MEDICARE: AMANDA 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	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
2	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1932525615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA RIOS

Provider Business Mailing Address
First Line	:	2106 BROOK HAVEN DR
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-4473
Country	:	US
Telephone Number	:	713-212-9098
Fax Number	:

Provider Business Practice Location Address
First Line	:	6012 CAMINO ALEGRE DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-2606
Country	:	US
Telephone Number	:	713-212-9098
Fax Number	:

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

Provider Enumeration Date	:	03/05/2014
Last Update Date	:	09/08/2014

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Directions to “ AMANDA RIOS ” Practice Location

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