Provider Demographics
NPI:1326037771
Name:RIOS, CONRAD (FNP)
Entity Type:Individual
Prefix:
First Name:CONRAD
Middle Name:
Last Name:RIOS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PROSPERITY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHOWCHILLA
Mailing Address - State:CA
Mailing Address - Zip Code:93610-8498
Mailing Address - Country:US
Mailing Address - Phone:559-664-4000
Mailing Address - Fax:559-675-5224
Practice Address - Street 1:300 PROSPERITY BLVD
Practice Address - Street 2:
Practice Address - City:CHOWCHILLA
Practice Address - State:CA
Practice Address - Zip Code:93610-8498
Practice Address - Country:US
Practice Address - Phone:559-664-4000
Practice Address - Fax:559-675-5224
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14483363A00000X
CA9240363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF89372Medicare UPIN
CAZZZ163572Medicare PIN
CABT385ZMedicare PIN
CA00G855610Medicare PIN