Healthcare Provider Details

I. General information

NPI: 1821587536
Provider Name (Legal Business Name): MURTAZA RIZVI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11645 WILSHIRE BLVD STE 1155
LOS ANGELES CA
90025-6807
US

IV. Provider business mailing address

11645 WILSHIRE BLVD STE 1155
LOS ANGELES CA
90025-6807
US

V. Phone/Fax

Practice location:
  • Phone: 424-293-8861
  • Fax: 424-293-8864
Mailing address:
  • Phone: 424-293-8861
  • Fax: 424-293-8864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA95879
License Number StateCA

VIII. Authorized Official

Name: MURTAZA RIZVI
Title or Position: OWNER
Credential: MD
Phone: 424-293-8861