Healthcare Provider Details

I. General information

NPI: 1386827749
Provider Name (Legal Business Name): HOUSE DOCTORS MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2007
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4902 IRVINE CENTER DR SUITE 105
IRVINE CA
92604-3305
US

IV. Provider business mailing address

PO BOX 51163
IRVINE CA
92619-1163
US

V. Phone/Fax

Practice location:
  • Phone: 949-262-1331
  • Fax: 760-862-9126
Mailing address:
  • Phone: 760-219-1311
  • Fax: 760-862-9126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA86212
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA86212
License Number StateCA

VIII. Authorized Official

Name: DR. TENGIS RIZNIS
Title or Position: CEO
Credential: M.D.
Phone: 760-219-1311