Provider Demographics
NPI:1063766111
Name:RIOS, NICOLE P (MS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:P
Last Name:RIOS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 VALLES AVE
Mailing Address - Street 2:3H
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2557
Mailing Address - Country:US
Mailing Address - Phone:347-843-8087
Mailing Address - Fax:
Practice Address - Street 1:5425 VALLES AVE
Practice Address - Street 2:3H
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2557
Practice Address - Country:US
Practice Address - Phone:347-843-8087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-28
Last Update Date:2012-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY658852121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist