Healthcare Provider Details

I. General information

NPI: 1285302349
Provider Name (Legal Business Name): RIOS ARIZONA IPA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3770 S 16TH AVE
TUCSON AZ
85713-6081
US

IV. Provider business mailing address

495 E RINCON ST STE 215
CORONA CA
92879-1378
US

V. Phone/Fax

Practice location:
  • Phone: 520-497-5480
  • Fax:
Mailing address:
  • Phone: 951-350-4901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAVIER R RIOS
Title or Position: PRESIDENT
Credential: MD
Phone: 520-497-5480