Healthcare Provider Details

I. General information

NPI: 1821434184
Provider Name (Legal Business Name): RIO VISTA SURGICAL ASSOCIATES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MOHAVE DR
PARKER AZ
85344
US

IV. Provider business mailing address

329 LAKE HAVASU AVE S
LAKE HAVASU CITY AZ
86403-9368
US

V. Phone/Fax

Practice location:
  • Phone: 928-453-2900
  • Fax: 928-453-3388
Mailing address:
  • Phone: 928-453-2900
  • Fax: 928-453-3388

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: DR. ABEDON ABE SAIZ
Title or Position: OWENER
Credential: M.D. FACS
Phone: 928-453-2900