Healthcare Provider Details

I. General information

NPI: 1861646689
Provider Name (Legal Business Name): MINA EFTEKHARI RIZI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 02/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 ATLANTIC AVE STE 4
LONG BEACH CA
90807-2833
US

IV. Provider business mailing address

4301 ATLANTIC AVE STE 4
LONG BEACH CA
90807-2833
US

V. Phone/Fax

Practice location:
  • Phone: 562-426-9308
  • Fax: 562-426-9300
Mailing address:
  • Phone: 562-426-9308
  • Fax: 562-426-9300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number57795
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: