Provider Demographics
NPI:1376841692
Name:YUMA REHABILITATION MEDICINE LLC
Entity Type:Organization
Organization Name:YUMA REHABILITATION MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RINELY
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUIAR-OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-329-4761
Mailing Address - Street 1:PO BOX 5298
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2465
Mailing Address - Country:US
Mailing Address - Phone:928-329-4761
Mailing Address - Fax:928-329-4448
Practice Address - Street 1:901 W 24TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6384
Practice Address - Country:US
Practice Address - Phone:928-329-4761
Practice Address - Fax:928-329-4448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28377208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty