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General NPI Number Information
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NPI Number | 1073107850
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Entity Type | Organization
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Legal Business Name | RIVIERA SURGICAL CENTER LLC
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Dates
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Enumeration Date | 02/23/2021
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 3003 AZ-95 #63
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442
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Country | US
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Telephone | 909-994-5105
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Fax |
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Provider Business Mailing Address
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Address Line | 3003 AZ-95 #63
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442
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Country | US
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Telephone | 928-483-4566
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Fax | 928-483-4566
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Authorized Official
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Title or Position | MEDICAL ASSISTANT
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Name | PAIGE HADDICK
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Credential | MA
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Telephone | 928-483-4566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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