Jibaro Medical Clinic PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

24947 Issued in AZ

Legal business name

JIBARO MEDICAL CLINIC PLLC

Practice address

5658 Highway 260
Suite 19
Lakeside, AZ 85929-5189

Phone

(928) 532-5838

Fax

(928) 532-6670

NPI assigned

Aug 5, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mirza Rivera, M.D.

Title

Owner

Phone

(923) 532-5838

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194734319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1150",
            "city": "SHOW LOW",
            "state": "AZ",
            "postal_code": "859021150",
            "telephone_number": "928-532-5838",
            "fax_number": "928-532-6670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5658 HIGHWAY 260",
            "address_2": "SUITE 19",
            "city": "LAKESIDE",
            "state": "AZ",
            "postal_code": "859295189",
            "telephone_number": "928-532-5838",
            "fax_number": "928-532-6670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JIBARO MEDICAL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RIVERA",
        "authorized_official_first_name": "MIRZA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "923-532-5838",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "24947",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Todd Barrett Jaffe, MD
• Jeffrey L Moffat MD PLLC
• Jeffrey M Reagan MD PLLC
• Jeffrey R Lesueur MD PC
• Scott Milton Jensen, M.D.
• John J Sullivan, DDS, PC
• Heather Keller
• Kent Walter Cox MD PS
• Thomas Melvin Kessler, M.D.
• Melissa Ann Kyrimis, MD

• Internal Medicine Physician in Lakeside, AZ
• Providers in Lakeside, AZ by specialty
• Internal Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.