Healthcare Provider Details

I. General information

NPI: 1124099940
Provider Name (Legal Business Name): JOSE RIOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 W IRVINGTON RD
TUCSON AZ
85714-3054
US

IV. Provider business mailing address

225 W IRVINGTON RD
TUCSON AZ
85714-3054
US

V. Phone/Fax

Practice location:
  • Phone: 520-884-7304
  • Fax: 520-623-0992
Mailing address:
  • Phone: 520-884-7304
  • Fax: 520-623-0992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number21070
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number21079
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: