Provider Demographics
NPI:1083623839
Name:RIOS, MARVIN JAVIER (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:JAVIER
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:P.O.BOX 652638
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33265-2638
Mailing Address - Country:US
Mailing Address - Phone:305-223-3131
Mailing Address - Fax:305-553-3888
Practice Address - Street 1:11880 SW 40TH ST
Practice Address - Street 2:SUITE 305
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3574
Practice Address - Country:US
Practice Address - Phone:305-223-3131
Practice Address - Fax:305-553-3888
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00632022080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL152851OtherWELLCARE
FL317OtherPREFERRED
FL9104693OtherPHCS
FL261960OtherBCBS
FL110950OtherHUMANA
FL215900OtherAMERIGROUP
FL2391939OtherAETNA
FL59933OtherVSTA OF SOUTH FLORIDA
FL1201096OtherUNITED
FL772763OtherFIRST HEALTH
FLME0063202OtherVISTA HEALTH PLAN
FL279502OtherAVMED
FL6035146002OtherCIGNA
FL173148OtherJMH
FL21149363532-02OtherBEECH STREET CORPORATION
FL33586OtherNHP
FL215900OtherAMERIGROUP
FL26196Medicare ID - Type Unspecified