=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821434184
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIO VISTA SURGICAL ASSOCIATES P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2013
-----------------------------------------------------
Last Update Date | 05/14/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1200 MOHAVE DR
-----------------------------------------------------
City | PARKER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-453-2900
-----------------------------------------------------
Fax | 928-453-3388
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 329 LAKE HAVASU AVE S
-----------------------------------------------------
City | LAKE HAVASU CITY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86403-9368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-453-2900
-----------------------------------------------------
Fax | 928-453-3388
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWENER
-----------------------------------------------------
Name | DR. ABEDON ABE SAIZ
-----------------------------------------------------
Credential | M.D. FACS
-----------------------------------------------------
Telephone | 928-453-2900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0129X
-----------------------------------------------------
Taxonomy Name | Vascular Surgery Physician
-----------------------------------------------------
License Number | 24387
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 24387
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------