Provider Demographics
NPI:1780663757
Name:RIOS-RODRIGUEZ, ADAN (LPN)
Entity Type:Individual
Prefix:
First Name:ADAN
Middle Name:
Last Name:RIOS-RODRIGUEZ
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 KEMPAIR DR
Mailing Address - Street 2:
Mailing Address - City:DALE CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22193-4633
Mailing Address - Country:US
Mailing Address - Phone:703-805-0679
Mailing Address - Fax:703-805-0189
Practice Address - Street 1:9501 FARRELL RD
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5901
Practice Address - Country:US
Practice Address - Phone:703-805-0679
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002050329164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse