1639206352 NPI number — MRS. STEPHANIE ANN RIOS MFT INTERN

Table of content: MRS. STEPHANIE ANN RIOS MFT INTERN (NPI 1639206352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639206352 NPI number — MRS. STEPHANIE ANN RIOS MFT INTERN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIOS
Provider First Name:
STEPHANIE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MFT INTERN
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:
1639206352
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1927
Provider Second Line Business Mailing Address:
P.O. BOX 1927
Provider Business Mailing Address City Name:
BIG BEAR LAKE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92315-1927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-866-5721
Provider Business Mailing Address Fax Number:
909-866-3228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41945 BIG BEAR BLVD.
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BIG BEAR LAKE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-866-5712
Provider Business Practice Location Address Fax Number:
909-866-3228
Provider Enumeration Date:
02/28/2007

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: 106H00000X , with the licence number:  IMF 42728 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5034 . This is a "MEDICAL SIMON NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: IMF 42728 . This is a "MFT INTERN NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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