Provider Demographics
NPI:1073107850
Name:RIVIERA SURGICAL CENTER LLC
Entity Type:Organization
Organization Name:RIVIERA SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:HADDICK
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:909-245-2381
Mailing Address - Street 1:3003 AZ-95
Mailing Address - Street 2:#63
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442
Mailing Address - Country:US
Mailing Address - Phone:909-245-2381
Mailing Address - Fax:
Practice Address - Street 1:3003 AZ-95
Practice Address - Street 2:#63
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442
Practice Address - Country:US
Practice Address - Phone:909-994-5105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-23
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical