Provider Demographics
NPI:1316454507
Name:RIOS, ANGELA MORENA I (RN,NP)
Entity type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:MORENA
Last Name:RIOS
Suffix:I
Gender:F
Credentials:RN,NP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:RIOS
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:RN,NP
Mailing Address - Street 1:751 W 129TH ST
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-1701
Mailing Address - Country:US
Mailing Address - Phone:310-494-1701
Mailing Address - Fax:
Practice Address - Street 1:1000 W CARSON ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2004
Practice Address - Country:US
Practice Address - Phone:310-222-3528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95008200208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice