Provider Demographics
NPI:1174580856
Name:RIOS, EDUARDO ALFONSO SR (MD)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:ALFONSO
Last Name:RIOS
Suffix:SR
Gender:M
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:PO BOX 902
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00954-0902
Mailing Address - Country:US
Mailing Address - Phone:787-870-3760
Mailing Address - Fax:787-870-2735
Practice Address - Street 1:32 ANTONIO LOPEZ
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00954-0902
Practice Address - Country:US
Practice Address - Phone:787-870-3760
Practice Address - Fax:787-870-2735
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15565208D00000X
PRZ022246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
2011301OtherPREFERRED HEALTH
PR22605R1OtherSSS
PR100553OtherCRUZ AZUL
3115565OtherUIA
825424OtherMEDICARE MUCHCO MAS
22605OtherTRIPLE S
PR0022605Medicare ID - Type Unspecified
PR22605R1OtherSSS