Provider Demographics
NPI:1114455656
Name:RIOS, CANDICE RENEE (MA, AREOLA ARTIST)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:RENEE
Last Name:RIOS
Suffix:
Gender:F
Credentials:MA, AREOLA ARTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 PARK CREST DR
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-3464
Mailing Address - Country:US
Mailing Address - Phone:817-751-8177
Mailing Address - Fax:
Practice Address - Street 1:6201 SUNSET DR STE 650
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5521
Practice Address - Country:US
Practice Address - Phone:817-751-8177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-29
Last Update Date:2017-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3DAREOLA246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82-1067523OtherTEXAS DEPARTMENT OF HEALTH