Provider Demographics
NPI:1538812797
Name:RIOS, ROMINA (RDA)
Entity type:Individual
Prefix:MISS
First Name:ROMINA
Middle Name:
Last Name:RIOS
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 CERRITOS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4570
Mailing Address - Country:US
Mailing Address - Phone:714-492-3866
Mailing Address - Fax:
Practice Address - Street 1:5001 CERRITOS AVE STE B
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-4570
Practice Address - Country:US
Practice Address - Phone:714-492-3866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA873041223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry