Provider Demographics
NPI:1528005410
Name:OROSI URGENT CARE,
Entity Type:Organization
Organization Name:OROSI URGENT CARE,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BENITO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PA-C
Authorized Official - Phone:559-528-6966
Mailing Address - Street 1:41696 ROAD 128
Mailing Address - Street 2:
Mailing Address - City:OROSI
Mailing Address - State:CA
Mailing Address - Zip Code:93647-2059
Mailing Address - Country:US
Mailing Address - Phone:559-528-6966
Mailing Address - Fax:559-528-3665
Practice Address - Street 1:41696 ROAD 128
Practice Address - Street 2:
Practice Address - City:OROSI
Practice Address - State:CA
Practice Address - Zip Code:93647-2059
Practice Address - Country:US
Practice Address - Phone:559-528-6966
Practice Address - Fax:559-528-3665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48642207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RHM08925FOtherRURAL HEALTH CLINIC IDENTIFIER
CAFNP34225OtherFICTITIOUS NAME PERMIT
CAZZZ02389ZOtherMEDICARE PROVIDER NUMBER