Basic Information
| Provider Information | |||||||||
| NPI: | 1497829949 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JAVIER R RIOS MD A MEDICAL PROFESSIONAL CORPORATION | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | TUCSON CLINICA MEDICA FAMILIAR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 70120 | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925130120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513434038 | ||||||||
| FaxNumber: | 9513593473 | ||||||||
| Practice Location | |||||||||
| Address1: | 3770 S 16TH AVE | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857136081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206201200 | ||||||||
| FaxNumber: | 5206201400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 01/15/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RIOS | ||||||||
| AuthorizedOfficialFirstName: | JAVIER | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | COE MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9513434038 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | JAVIER R RIOS MD A PROFESSIONAL CORPORATION | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 30370 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | Z78590 | 01 | AZ | MEDICARE PIN | OTHER | 706393 | 01 | AZ | AHCCCS | OTHER | 78444 | 01 | AZ | MEDICARE PIN | OTHER |