Provider Demographics
NPI:1639246176
Name:RIOS, JAVIER R (MD)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:R
Last Name:RIOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:495 E RINCON ST STE 215
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-1378
Mailing Address - Country:US
Mailing Address - Phone:951-523-0117
Mailing Address - Fax:951-475-7013
Practice Address - Street 1:9939 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3528
Practice Address - Country:US
Practice Address - Phone:855-505-7467
Practice Address - Fax:888-975-8926
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53521207Q00000X, 207Q00000X, 207Q00000X
CA0A535212082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A535210Medicaid
AZ713067/ 706393OtherAHCCCS MEDICAID
AZ713067/ 706393OtherAHCCCS MEDICAID
CA00A535210Medicaid
AZZ78590 /78444Medicare PIN
CA00A535210Medicare PIN