Provider Demographics
NPI:1912273012
Name:RIOS, TABATHA L (MD)
Entity type:Individual
Prefix:DR
First Name:TABATHA
Middle Name:L
Last Name:RIOS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:
Practice Address - Street 1:28516 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-3210
Practice Address - Country:US
Practice Address - Phone:813-815-8391
Practice Address - Fax:813-761-3347
Is Sole Proprietor?:No
Enumeration Date:2012-03-23
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36137078207Q00000X
FLME138093207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL191227013Medicaid
FL1912273012Medicaid
FL101147800Medicaid