1497829949 NPI number — JAVIER R RIOS MD A MEDICAL PROFESSIONAL CORPORATION

Table of content: (NPI 1497829949)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497829949 NPI number — JAVIER R RIOS MD A MEDICAL PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAVIER R RIOS MD A MEDICAL 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:
Provider Other Organization Name Type Code:
6
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:
1497829949
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2025
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:
951-523-0117
Provider Business Mailing Address Fax Number:
951-394-0685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3770 S 16TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85713-6081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-620-1200
Provider Business Practice Location Address Fax Number:
520-620-1400
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RIOS
Authorized Official First Name:
JAVIER
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CEO/ MEDICAL DIRECTOR
Authorized Official Telephone Number:
951-523-0117

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  30370 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Z78590 . This is a "MEDICARE PIN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 78444 . This is a "MEDICARE PIN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 706393 . This is a "AHCCCS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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