Provider Demographics
NPI:1619434768
Name:RIOS, JUAN PABLO (LVN)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:PABLO
Last Name:RIOS
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3441 DATA DR APT 368
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7996
Mailing Address - Country:US
Mailing Address - Phone:915-205-0215
Mailing Address - Fax:
Practice Address - Street 1:3441 DATA DR APT 368
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-7996
Practice Address - Country:US
Practice Address - Phone:915-205-0215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA685785164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty