Provider Demographics
NPI:1326147950
Name:RIOS, MARINA CORTINOVIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARINA
Middle Name:CORTINOVIS
Last Name:RIOS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12331 1/4 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-5509
Mailing Address - Country:US
Mailing Address - Phone:310-397-6015
Mailing Address - Fax:310-397-6715
Practice Address - Street 1:12331 1/4 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5509
Practice Address - Country:US
Practice Address - Phone:310-397-6015
Practice Address - Fax:310-397-6715
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA447701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93393-01OtherMEDI-CAL PROVIDER ID