Healthcare Provider Details

I. General information

NPI: 1528005410
Provider Name (Legal Business Name): OROSI URGENT CARE,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41696 ROAD 128
OROSI CA
93647-2059
US

IV. Provider business mailing address

41696 ROAD 128
OROSI CA
93647-2059
US

V. Phone/Fax

Practice location:
  • Phone: 559-528-6966
  • Fax: 559-528-3665
Mailing address:
  • Phone: 559-528-6966
  • Fax: 559-528-3665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG48642
License Number StateCA

VIII. Authorized Official

Name: MR. BENITO RIVAS JR.
Title or Position: CEO
Credential: PA-C
Phone: 559-528-6966