Provider Demographics
NPI:1538243829
Name:RIOS, JACINTO T (MD)
Entity type:Individual
Prefix:DR
First Name:JACINTO
Middle Name:T
Last Name:RIOS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:18350 ROSCOE BLVD
Mailing Address - Street 2:SUITE 718
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4109
Mailing Address - Country:US
Mailing Address - Phone:818-993-8201
Mailing Address - Fax:818-993-8209
Practice Address - Street 1:18350 ROSCOE BLVD
Practice Address - Street 2:SUITE 718
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4109
Practice Address - Country:US
Practice Address - Phone:818-993-8201
Practice Address - Fax:818-993-8209
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA23320208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23479Medicare UPIN