Provider Demographics
NPI:1154483550
Name:DE LOS RIOS, MARTHA EUGENIA
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:EUGENIA
Last Name:DE LOS RIOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:EUGENIA
Other - Last Name:DE LOS RIOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:866 SPOTTED PONY LN
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5467
Mailing Address - Country:US
Mailing Address - Phone:916-960-8454
Mailing Address - Fax:
Practice Address - Street 1:3433 ARDEN WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2018
Practice Address - Country:US
Practice Address - Phone:916-984-4224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA537811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice