1598291015 NPI number — DR. JAVIER RIOS, A MEDICAL CORPORATION

Table of content: DR. SHARON LEE LEVIN M.D. (NPI 1982784013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598291015 NPI number — DR. JAVIER RIOS, A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. JAVIER RIOS, A MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MISSION TRAIL CLINICA MEDICA FAMILIAR
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598291015
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
495 E RINCON ST STE 215
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORONA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92879-1378
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-523-0117
Provider Business Mailing Address Fax Number:
951-394-0685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31946 MISSION TRL STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE ELSINORE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92530-4539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-505-7467
Provider Business Practice Location Address Fax Number:
888-975-8926
Provider Enumeration Date:
05/03/2017

Additional Information

Authorized Official

Authorized Official Last Name:
RIOS
Authorized Official First Name:
JAVIER
Authorized Official Middle Name:
R
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
951-354-3221

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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