Healthcare Provider Details

I. General information

NPI: 1699765834
Provider Name (Legal Business Name): RIO VISTA SURGICAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 04/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 RIVIERA DR
LAKE HAVASU CITY AZ
86403-5716
US

IV. Provider business mailing address

90 RIVIERA DR
LAKE HAVASU CITY AZ
86403-5716
US

V. Phone/Fax

Practice location:
  • Phone: 928-453-2900
  • Fax: 877-864-6566
Mailing address:
  • Phone: 928-453-2900
  • Fax: 877-864-6566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number24387
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number24387
License Number StateAZ

VIII. Authorized Official

Name: ABEDON ABE SAIZ JR.
Title or Position: MD/OWNER
Credential: MD
Phone: 928-453-2900