Provider Demographics
NPI:1982494712
Name:GOVEA, RIO (LAC)
Entity type:Individual
Prefix:
First Name:RIO
Middle Name:
Last Name:GOVEA
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2907 BRUSH ST
Mailing Address - Street 2:
Mailing Address - City:GRATON
Mailing Address - State:CA
Mailing Address - Zip Code:95444-9315
Mailing Address - Country:US
Mailing Address - Phone:510-890-5059
Mailing Address - Fax:
Practice Address - Street 1:120 PLEASANT HILL AVE N STE 200K
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3167
Practice Address - Country:US
Practice Address - Phone:510-890-5059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19864171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist