1245534486 NPI number — JASMIN DE LOS ANGELES RIOS

Table of content: JASMIN DE LOS ANGELES RIOS (NPI 1245534486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245534486 NPI number — JASMIN DE LOS ANGELES RIOS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIOS
Provider First Name:
JASMIN
Provider Middle Name:
DE LOS ANGELES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245534486
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2051 MARTIN LUTHER KING JR BLVD
Provider Second Line Business Mailing Address:
SUIT 101
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33404-7004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-683-4778
Provider Business Mailing Address Fax Number:
561-683-9995

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2051 MARTIN LUTHER KING JR BLVD
Provider Second Line Business Practice Location Address:
SUIT 101
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33404-7004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-683-4778
Provider Business Practice Location Address Fax Number:
561-683-9995
Provider Enumeration Date:
01/03/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 023523000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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