Healthcare Provider Details

I. General information

NPI: 1881078780
Provider Name (Legal Business Name): MIGUEL ANGEL TOSADO RIVERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2851 S AVENUE B BLDG 20
YUMA AZ
85364-7726
US

IV. Provider business mailing address

2851 S AVENUE B BLDG 20
YUMA AZ
85364-7726
US

V. Phone/Fax

Practice location:
  • Phone: 928-336-2434
  • Fax: 928-336-2435
Mailing address:
  • Phone: 928-336-2434
  • Fax: 928-336-2435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number29892-R
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number50418
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: