Provider Demographics
NPI:1073677761
Name:LUIS A RIOS MD PA
Entity Type:Organization
Organization Name:LUIS A RIOS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-389-7467
Mailing Address - Street 1:1604 TOWN CENTER CIR
Mailing Address - Street 2:SUITE D
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3640
Mailing Address - Country:US
Mailing Address - Phone:954-389-7467
Mailing Address - Fax:954-217-8998
Practice Address - Street 1:1586 BLUE JAY CIR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33327-2007
Practice Address - Country:US
Practice Address - Phone:954-389-7467
Practice Address - Fax:954-217-8998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70796208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty