Healthcare Provider Details

I. General information

NPI: 1063387538
Provider Name (Legal Business Name): DR. JAVIER RIOS, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49867 29 PALMS HWY
MORONGO VALLEY CA
92256-9776
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 855-505-7467
  • Fax: 888-975-8926
Mailing address:
  • Phone: 951-354-3221
  • Fax: 951-394-0685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) 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: OWNER
Credential: MD
Phone: 951-354-3221