Provider Demographics
NPI:1831370576
Name:INTERNAL MEDICINE OF YUMA LLC
Entity type:Organization
Organization Name:INTERNAL MEDICINE OF YUMA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RINELY
Authorized Official - Middle Name:R
Authorized Official - Last Name:AGUIAR-OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-329-4761
Mailing Address - Street 1:2285 S ELKS LN
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6258
Mailing Address - Country:US
Mailing Address - Phone:928-329-4761
Mailing Address - Fax:928-329-6742
Practice Address - Street 1:2285 S ELKS LN
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6258
Practice Address - Country:US
Practice Address - Phone:928-329-4761
Practice Address - Fax:928-329-4448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-23
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28377207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1831370576OtherBLUE CROSS AND BLUE SHIELD
AZ51607302Medicaid
AZ1831370576OtherHEALTHNET
AZ119162Medicare PIN
AZ1831370576OtherBLUE CROSS AND BLUE SHIELD