Provider Demographics
NPI:1972355121
Name:RIOS, ALBERT VITELIO
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:VITELIO
Last Name:RIOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 BOYNTON ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-3407
Mailing Address - Country:US
Mailing Address - Phone:818-482-6544
Mailing Address - Fax:
Practice Address - Street 1:4141 S NOGALES ST UNIT A104
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-3057
Practice Address - Country:US
Practice Address - Phone:619-399-9906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician