Provider Demographics
NPI:1609972777
Name:RIO HONDO MEDICAL GROUP INC
Entity Type:Organization
Organization Name:RIO HONDO MEDICAL GROUP INC
Other - Org Name:RIO HONDO PEDIATRICS ASSOCIATES MEDICALR GROUP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-698-0161
Mailing Address - Street 1:12444 E WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-1005
Mailing Address - Country:US
Mailing Address - Phone:562-698-0161
Mailing Address - Fax:562-688-8740
Practice Address - Street 1:12444 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1005
Practice Address - Country:US
Practice Address - Phone:562-698-0161
Practice Address - Fax:562-698-8740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38728207Q00000X
CAA23965208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty