Healthcare Provider Details

I. General information

NPI: 1366675571
Provider Name (Legal Business Name): RIYAZ SADRUDDIN MASANI MCS, MBA, LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 02/13/2021
Certification Date: 02/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

458 DARLINGTON WAY
LINCOLN CA
95648-2927
US

IV. Provider business mailing address

322 NASSAU LN
HAYWARD CA
94544-7320
US

V. Phone/Fax

Practice location:
  • Phone: 916-459-8686
  • Fax:
Mailing address:
  • Phone: 916-459-8686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number237193
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: