Provider Demographics
NPI:1679203202
Name:RIO VISTA HOLISTIC HEALTH CENTER
Entity Type:Organization
Organization Name:RIO VISTA HOLISTIC HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER AND OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARREL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:707-374-3142
Mailing Address - Street 1:500 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIO VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:94571-1619
Mailing Address - Country:US
Mailing Address - Phone:707-374-3142
Mailing Address - Fax:707-374-3148
Practice Address - Street 1:500 MAIN ST
Practice Address - Street 2:
Practice Address - City:RIO VISTA
Practice Address - State:CA
Practice Address - Zip Code:94571-1619
Practice Address - Country:US
Practice Address - Phone:707-374-3142
Practice Address - Fax:707-374-3148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center