Provider Demographics
NPI:1003870312
Name:RIOS, MARINO A (MD)
Entity Type:Individual
Prefix:
First Name:MARINO
Middle Name:A
Last Name:RIOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 N MESA
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902
Mailing Address - Country:US
Mailing Address - Phone:915-533-1626
Mailing Address - Fax:915-533-1641
Practice Address - Street 1:1714 N MESA
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902
Practice Address - Country:US
Practice Address - Phone:915-533-1626
Practice Address - Fax:915-533-1641
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1220207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1516905OtherECFMG
TX114556702Medicaid
TX114556702Medicaid
C21088Medicare UPIN