1235138363 NPI number — JAVIER R RIOS MD, A PROFESSIONAL CORPORATION

Table of content: (NPI 1235138363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235138363 NPI number — JAVIER R RIOS MD, A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAVIER R RIOS MD, A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MAGNOLIA CLINICA MEDICA FAMILIAR / CHICAGO CLINICA MEDICA FAMILIAR
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235138363
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
495 E RINCON ST STE 215
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORONA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92879-1378
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-354-3221
Provider Business Mailing Address Fax Number:
951-394-0685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9939 MAGNOLIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92503-3528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-505-7467
Provider Business Practice Location Address Fax Number:
888-975-8926
Provider Enumeration Date:
07/20/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RIOS
Authorized Official First Name:
JAVIER
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER / MEDICAL DIRECTOR
Authorized Official Telephone Number:
951-354-3221

Provider Taxonomy Codes

  • Taxonomy code: 207NS0135X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 0A53521 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2082S0099X , with the licence number: 0A53521 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GR0083641 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0083640 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".