Provider Demographics
NPI:1497829949
Name:JAVIER R RIOS MD A MEDICAL PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JAVIER R RIOS MD A MEDICAL PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ MEDICAL DIRECTOR
Authorized Official - Prefix:DR
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:951-523-0117
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:951-394-0685
Practice Address - Street 1:3770 S 16TH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-6081
Practice Address - Country:US
Practice Address - Phone:520-620-1200
Practice Address - Fax:520-620-1400
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAVIER R RIOS MD A PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-17
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30370207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ78590OtherMEDICARE PIN
AZ78444OtherMEDICARE PIN
AZ706393OtherAHCCCS
F94071Medicare UPIN
AZ78444Medicare PIN