Provider Demographics
NPI:1104409291
Name:RIOS, MARIANNE DAMIAN (PA)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:DAMIAN
Last Name:RIOS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 SAINT MICHAEL DR STE 401
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-5211
Mailing Address - Country:US
Mailing Address - Phone:903-614-5368
Mailing Address - Fax:903-614-5343
Practice Address - Street 1:2833 BABCOCK RD STE 203
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4894
Practice Address - Country:US
Practice Address - Phone:210-705-5100
Practice Address - Fax:210-705-5106
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant