Provider Demographics
NPI:1083144786
Name:CAC, EVA RIOS
Entity Type:Individual
Prefix:MRS
First Name:EVA
Middle Name:RIOS
Last Name:CAC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8825 STANWELL ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-2813
Mailing Address - Country:US
Mailing Address - Phone:858-695-8132
Mailing Address - Fax:858-695-8132
Practice Address - Street 1:8825 STANWELL ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-2813
Practice Address - Country:US
Practice Address - Phone:858-695-8132
Practice Address - Fax:858-695-8132
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374602492376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator