Provider Demographics
NPI:1417219767
Name:RIOS, JOSE (BCBA)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:RIOS
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 ROOSEVELT BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-4480
Mailing Address - Country:US
Mailing Address - Phone:805-985-4808
Mailing Address - Fax:805-985-7623
Practice Address - Street 1:2323 ROOSEVELT BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93035-4480
Practice Address - Country:US
Practice Address - Phone:805-985-4808
Practice Address - Fax:805-985-7623
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-00-0288103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst