Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 95018021 | CA |
N | 363LP2300X | Nurse Practitioner - Primary Care | 95018021 | CA |
NPI | 1033885991 |
---|---|
Provider Name | Alicia Berenice Rios |
First Address | Cathedral City, CA 92234-3899 |
Second Address | Palm Springs, CA 92262-4868 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2021 |
Last Update Date | 20/08/2021 |