Provider Demographics
NPI:1497455810
Name:RIOS, NELSON OMAR (NP)
Entity Type:Individual
Prefix:MR
First Name:NELSON
Middle Name:OMAR
Last Name:RIOS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 N INDIAN CANYON DR STE 420
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4859
Mailing Address - Country:US
Mailing Address - Phone:760-778-7147
Mailing Address - Fax:
Practice Address - Street 1:1180 N INDIAN CANYON DR STE 420
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4859
Practice Address - Country:US
Practice Address - Phone:760-778-7147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024493363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily