Provider Demographics
NPI:1346328002
Name:RIOS, RAFAEL AUGUSTO (DC)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:AUGUSTO
Last Name:RIOS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10355 MESQUITE RD.
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91737
Mailing Address - Country:US
Mailing Address - Phone:909-980-2392
Mailing Address - Fax:
Practice Address - Street 1:1232 N PARK AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-3029
Practice Address - Country:US
Practice Address - Phone:909-623-9621
Practice Address - Fax:909-623-0064
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11643111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2652626Medicaid
CA2652626Medicaid