Provider Demographics
NPI:1417668583
Name:RIOS, MICHELLE SOPHIA (MA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SOPHIA
Last Name:RIOS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. SENDEROS DE JUNCOS
Mailing Address - Street 2:104 CALLE TORONJA
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-7610
Mailing Address - Country:US
Mailing Address - Phone:787-469-3883
Mailing Address - Fax:
Practice Address - Street 1:AVE. VALERO ESQ. OSVALDO MOLINA
Practice Address - Street 2:CARR. 194
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-860-1987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7600103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist