Provider Demographics
NPI:1942631460
Name:DR. JAVIER RIOS A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DR. JAVIER RIOS A MEDICAL CORPORATION
Other - Org Name:MEAD VALLEY CLINICA MEDICA FAMILIAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:R
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-354-3221
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 1:21091 RIDER ST
Practice Address - Street 2:STE 218
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-8800
Practice Address - Country:US
Practice Address - Phone:855-505-7467
Practice Address - Fax:888-975-8926
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. JAVIER RIOS A MEDICAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-09
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1942631460Medicaid
CA1942631460Medicaid