Provider Demographics
NPI:1710528567
Name:RIOS VALLE, ROBERTO JR (APRN FMP)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:RIOS VALLE
Suffix:JR
Gender:M
Credentials:APRN FMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5007 GOLDEN GATE DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-3799
Mailing Address - Country:US
Mailing Address - Phone:817-223-2937
Mailing Address - Fax:
Practice Address - Street 1:5007 GOLDEN GATE DR
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-3799
Practice Address - Country:US
Practice Address - Phone:817-223-2937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX676242363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily