Healthcare Provider Details

I. General information

NPI: 1104429570
Provider Name (Legal Business Name): DR. JAVIER RIOS, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27625 JEFFERSON AVE STE 101
TEMECULA CA
92590-2619
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 951-676-9666
  • Fax: 951-676-5647
Mailing address:
  • Phone: 951-523-0117
  • Fax: 951-394-0685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JAVIER R RIOS
Title or Position: OWNER/DIRECTOR
Credential: MD
Phone: 951-354-3221