Provider Demographics
NPI:1699347864
Name:RIOS, ESTEBAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:ESTEBAN
Middle Name:
Last Name:RIOS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PARC. AMALIA MARIN 4968 CALLE ROBERTO BARACOA COLLADO
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-1340
Mailing Address - Country:US
Mailing Address - Phone:787-215-5833
Mailing Address - Fax:
Practice Address - Street 1:35 CALLE MAYOR
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3726
Practice Address - Country:US
Practice Address - Phone:787-844-3077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7051103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical