1649510496 NPI number — RIO VISTA AFH

Table of content: (NPI 1649510496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649510496 NPI number — RIO VISTA AFH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIO VISTA AFH
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:
FRENCH ROAD SPRINGS
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:
1649510496
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10106 SE FRENCH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98664-3726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-253-6813
Provider Business Mailing Address Fax Number:
360-253-8405

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10106 SE FRENCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98664-3726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-253-6813
Provider Business Practice Location Address Fax Number:
360-253-8405
Provider Enumeration Date:
02/14/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ORTIZ
Authorized Official First Name:
BELEN
Authorized Official Middle Name:
NONE
Authorized Official Title or Position:
OWNER/PROVIDER
Authorized Official Telephone Number:
360-253-6813

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  613900 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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