Provider Demographics
NPI:1447495411
Name:RIOS, MICHELLE FABIOLA (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:FABIOLA
Last Name:RIOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9449 IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-2814
Mailing Address - Country:US
Mailing Address - Phone:800-823-4040
Mailing Address - Fax:
Practice Address - Street 1:1245 16TH ST
Practice Address - Street 2:SUITE 125
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1235
Practice Address - Country:US
Practice Address - Phone:310-319-4377
Practice Address - Fax:310-319-4425
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110502207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1447495411Medicaid
CAFO132ZMedicare PIN