Provider Demographics
NPI:1245536333
Name:RIOJAS, JUAN ANTONIO (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:ANTONIO
Last Name:RIOJAS
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1141 N BRAND BLVD
Mailing Address - Street 2:STE 302
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2511
Mailing Address - Country:US
Mailing Address - Phone:818-549-0977
Mailing Address - Fax:818-450-0950
Practice Address - Street 1:11870 SANTA MONICA BLVD
Practice Address - Street 2:201
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2276
Practice Address - Country:US
Practice Address - Phone:310-979-8378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21429363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADD035AMedicare UPIN
CAFR876ZMedicare PIN