Provider Demographics
NPI:1093689713
Name:RANCHO RIOS DOMINGUEZ
Entity type:Organization
Organization Name:RANCHO RIOS DOMINGUEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSTRUCTOR COACH
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:JOANNE
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:CBEIP
Authorized Official - Phone:575-621-5913
Mailing Address - Street 1:PO BOX 163
Mailing Address - Street 2:
Mailing Address - City:CHAMBERINO
Mailing Address - State:NM
Mailing Address - Zip Code:88027-0163
Mailing Address - Country:US
Mailing Address - Phone:575-621-5913
Mailing Address - Fax:
Practice Address - Street 1:230 EL PESCADO RD
Practice Address - Street 2:
Practice Address - City:CHAMBERINO
Practice Address - State:NM
Practice Address - Zip Code:88027-9005
Practice Address - Country:US
Practice Address - Phone:575-621-5913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-04
Last Update Date:2025-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No251300000XAgenciesLocal Education Agency (LEA)
No251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management