Provider Demographics
NPI:1508383191
Name:DEL RIO, JANNARETH (BA)
Entity Type:Individual
Prefix:MS
First Name:JANNARETH
Middle Name:
Last Name:DEL RIO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1371 ENCHANTED TRL
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92582-4234
Mailing Address - Country:US
Mailing Address - Phone:951-588-7556
Mailing Address - Fax:
Practice Address - Street 1:1371 ENCHANTED TRL
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92582-4234
Practice Address - Country:US
Practice Address - Phone:951-588-7556
Practice Address - Fax:951-588-7556
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst