Provider Demographics
NPI:1821434184
Name:RIO VISTA SURGICAL ASSOCIATES P.C.
Entity Type:Organization
Organization Name:RIO VISTA SURGICAL ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABEDON
Authorized Official - Middle Name:ABE
Authorized Official - Last Name:SAIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACS
Authorized Official - Phone:928-453-2900
Mailing Address - Street 1:329 LAKE HAVASU AVE S
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-9368
Mailing Address - Country:US
Mailing Address - Phone:928-453-2900
Mailing Address - Fax:928-453-3388
Practice Address - Street 1:1200 MOHAVE DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344
Practice Address - Country:US
Practice Address - Phone:928-453-2900
Practice Address - Fax:928-453-3388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24387208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty