Provider Demographics
NPI:1093452963
Name:RIOS, RAQUELLE Y
Entity Type:Individual
Prefix:
First Name:RAQUELLE
Middle Name:Y
Last Name:RIOS
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:PO BOX 8193
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77508-8193
Mailing Address - Country:US
Mailing Address - Phone:832-264-9725
Mailing Address - Fax:
Practice Address - Street 1:14930 SCOTTER DR
Practice Address - Street 2:
Practice Address - City:CHANNELVIEW
Practice Address - State:TX
Practice Address - Zip Code:77530-2006
Practice Address - Country:US
Practice Address - Phone:832-264-9725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-12
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX881398365Medicaid