Provider Demographics
NPI:1629618293
Name:RIOS GRANT, GRETCHEN ANGELICA
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:ANGELICA
Last Name:RIOS GRANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 3026
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-9396
Mailing Address - Country:US
Mailing Address - Phone:939-464-4462
Mailing Address - Fax:
Practice Address - Street 1:CARR 402 KM 3.9 BO CARACOL
Practice Address - Street 2:
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-9396
Practice Address - Country:US
Practice Address - Phone:939-464-4462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program