Provider Demographics
NPI:1992112544
Name:RIOS, RYAN (RD/LD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:RIOS
Suffix:
Gender:M
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7617 BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-7907
Mailing Address - Country:US
Mailing Address - Phone:956-792-8218
Mailing Address - Fax:
Practice Address - Street 1:7617 BLOSSOM DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-7907
Practice Address - Country:US
Practice Address - Phone:956-792-8218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82095133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered