Organization
JIBARO MEDICAL CLINIC PLLC
Active
Organization
JIBARO MEDICAL CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIRZA RIVERA M.D. (OWNER)
(923) 532-5838
Entity
Organization
Contact information
Practice address
5658 HIGHWAY 260, SUITE 19, LAKESIDE, AZ 85929-5189
(928) 532-5838
(928) 532-6670
Mailing address
PO BOX 1150, SHOW LOW, AZ 85902-1150
(928) 532-5838
(928) 532-6670
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
24947
AZ
Other
Enumeration date
08/05/2006
Last updated
08/22/2020
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