Provider Demographics
NPI:1407058621
Name:RIOS, KEITH E
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:E
Last Name:RIOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8041 GREENBACK LN
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-6909
Mailing Address - Country:US
Mailing Address - Phone:916-721-0400
Mailing Address - Fax:916-721-0434
Practice Address - Street 1:1508 S. WINCHESTER BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0519
Practice Address - Country:US
Practice Address - Phone:408-379-5600
Practice Address - Fax:408-379-5632
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA5058237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA 5058OtherLICENCE