Provider Demographics
NPI:1417117037
Name:RIOJAS, EDWARD (EDDIE) D (ADMINISTRATOR)
Entity Type:Individual
Prefix:MR
First Name:EDWARD (EDDIE)
Middle Name:D
Last Name:RIOJAS
Suffix:
Gender:M
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14212 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ATASCOSA
Mailing Address - State:TX
Mailing Address - Zip Code:78002
Mailing Address - Country:US
Mailing Address - Phone:830-709-3541
Mailing Address - Fax:830-709-3541
Practice Address - Street 1:14212 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:ATASCOSA
Practice Address - State:TX
Practice Address - Zip Code:78002-4765
Practice Address - Country:US
Practice Address - Phone:830-709-3541
Practice Address - Fax:830-709-3541
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000641310400000X
TX#121471310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility