Healthcare Provider Details

I. General information

NPI: 1164591509
Provider Name (Legal Business Name): SHAFQAT RIZVI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 E 120TH ST
LOS ANGELES CA
90059-3052
US

IV. Provider business mailing address

20710 AMIE AVE APT. 129
TORRANCE CA
90503-3620
US

V. Phone/Fax

Practice location:
  • Phone: 310-668-4369
  • Fax:
Mailing address:
  • Phone: 310-921-9417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA97251
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: