Provider Demographics
NPI:1083115034
Name:RIOS, ANGEL EDGAR (LAT)
Entity Type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:EDGAR
Last Name:RIOS
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 LEWIS DR
Mailing Address - Street 2:
Mailing Address - City:BURNET
Mailing Address - State:TX
Mailing Address - Zip Code:78611-2004
Mailing Address - Country:US
Mailing Address - Phone:817-219-6210
Mailing Address - Fax:
Practice Address - Street 1:1002 LEWIS DR
Practice Address - Street 2:
Practice Address - City:BURNET
Practice Address - State:TX
Practice Address - Zip Code:78611-2004
Practice Address - Country:US
Practice Address - Phone:817-219-6210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT60342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer