Healthcare Provider Details

I. General information

NPI: 1396086674
Provider Name (Legal Business Name): DR. WILLY J RIOS-ARAICO,MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2013
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 3RD AVE STE 2200
CHULA VISTA CA
91911-1353
US

IV. Provider business mailing address

855 3RD AVE STE 2200
CHULA VISTA CA
91911-1353
US

V. Phone/Fax

Practice location:
  • Phone: 619-426-0100
  • Fax: 619-426-2170
Mailing address:
  • Phone: 619-426-0100
  • Fax: 619-426-2170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberA342950
License Number StateCA

VIII. Authorized Official

Name: DR. WILLY J RIOS-ARAICO
Title or Position: PRESIDENT
Credential: MD
Phone: 619-426-0100