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General NPI Number Information
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NPI Number | 1033418785
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Entity Type | Organization
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Legal Business Name | DR. JAVIER RIOS, A MEDICAL CORPORATION
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Dates
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Enumeration Date | 03/21/2011
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Last Update Date | 06/06/2022
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Provider Practice Location Address
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Address Line | 141 N MAIN ST
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City | LAKE ELSINORE
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State | CA
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Zip | 92530-4118
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Country | US
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Telephone | 855-505-7467
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Fax | 888-975-8926
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Provider Business Mailing Address
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Address Line | 495 E RINCON ST STE 215
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City | CORONA
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State | CA
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Zip | 92879-1378
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Country | US
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Telephone | 951-523-0117
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Fax | 951-394-0685
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Authorized Official
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Title or Position | CEO
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Name | JAVIER R RIOS
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Credential | MD
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Telephone | 951-354-3221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A53521
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License Number State | CA
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