Provider Demographics
NPI:1770277493
Name:DEL RIO, LISA ARIELLA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ARIELLA
Last Name:DEL RIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA ARIELLA
Other - Middle Name:FRANCISCO
Other - Last Name:DEL RIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:936 SEQUOIA RUBY CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-8656
Mailing Address - Country:US
Mailing Address - Phone:951-768-3003
Mailing Address - Fax:
Practice Address - Street 1:1360 W HORIZON RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-2462
Practice Address - Country:US
Practice Address - Phone:702-568-9459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV23187183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist