Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 35.143021 | OH |
N | 2081S0010X | Sports Medicine | 22392 | PR |
N | 213ES0000X | Sports Medicine | 22392 | PR |
NPI | 1336537695 |
---|---|
Provider Name | Dr. Jose Luis Rios Russo |
First Address | Cincinnati, OH 45206-1785 |
Second Address | Cincinnati, OH 45216-1015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2015 |
Last Update Date | 12/08/2021 |