Provider Demographics
NPI:1467586552
Name:RIO NUEVO FAMILY PRACTICE, P.C.
Entity Type:Organization
Organization Name:RIO NUEVO FAMILY PRACTICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FREDELITO
Authorized Official - Middle Name:BARRIOS
Authorized Official - Last Name:TIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-792-8300
Mailing Address - Street 1:1702 W ANKLAM RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2606
Mailing Address - Country:US
Mailing Address - Phone:520-792-8300
Mailing Address - Fax:520-792-8303
Practice Address - Street 1:1702 W ANKLAM RD
Practice Address - Street 2:SUITE 110
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2606
Practice Address - Country:US
Practice Address - Phone:520-792-8300
Practice Address - Fax:520-792-8303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27319261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ75523Medicare ID - Type Unspecified
AZH46938Medicare UPIN