# MARIPOSA COMMUNITY HEALTH CENTER, INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MARIPOSA COMMUNITY HEALTH CENTER, INC
- **Other names:** Mariposa Community Health Center, Inc.-Dental, Rio Rico
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1073373536
- **Legal business name:** MARIPOSA COMMUNITY HEALTH CENTER, INC
- **Authorized official:** AMY TAYLOR (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (520) 761-2128

## Contact information

- **Practice address:** 1103 CIRCULO MERCADO, RIO RICO, AZ 85648-6248
- **Practice address phone:** (520) 375-5032
- **Practice address fax:** (520) 761-2159
- **Mailing address:** 825 N GRAND AVE STE 100, NOGALES, AZ 85621-1061
- **Mailing address phone:** (520) 761-2133
- **Mailing address fax:** (520) 281-1112

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | — |
| 122300000X | Dentist | — | — | — |
| 1223D0001X | Public Health Dentistry | — | NULL | — |
| 1223D0001X | Public Health Dentistry | — | — | — |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 124Q00000X | Dental Hygienist | — | NULL | — |
| 124Q00000X | Dental Hygienist | — | — | — |
| 261QD0000X | Dental Clinic/Center | — | NULL | — |
| 261QF0400X | Federally Qualified Health Center (FQHC) | — | NULL | — |

## Other

- **Enumeration date:** 03/21/2024
- **Last updated:** 02/17/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1013213404 | GROUP NPI | — |