Provider Demographics
NPI:1285619437
Name:RIOS, SANDRA IDANIS (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:IDANIS
Last Name:RIOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PMB 246
Mailing Address - Street 2:P.O. BOX 4002
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-4002
Mailing Address - Country:US
Mailing Address - Phone:787-883-2732
Mailing Address - Fax:787-883-2732
Practice Address - Street 1:CALLE MUNOZ RIVERA
Practice Address - Street 2:#4
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-0000
Practice Address - Country:US
Practice Address - Phone:787-883-2732
Practice Address - Fax:787-883-2732
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11637207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR87955-RMedicare ID - Type UnspecifiedMEDICARE
PRG40978Medicare UPIN