Basic Information
Provider Information
NPI: 1679145700
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RIOUX
FirstName: PAULINE
MiddleName: N
NamePrefix: MISS
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5767 W CENTURY BLVD SUITE 400
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900955631
CountryCode: US
TelephoneNumber: 3103018707
FaxNumber: 3103018751
Practice Location
Address1: 757 WESTWOOD PLZ STE 3325
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900954724
CountryCode: US
TelephoneNumber: 3103018707
FaxNumber: 3102673899
Other Information
ProviderEnumerationDate: 07/16/2021
LastUpdateDate: 11/23/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/23/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X95001553CAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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