Healthcare Provider Details

I. General information

NPI: 1326072380
Provider Name (Legal Business Name): RIQUAZA ZAINUL ZAVAHIR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ZAINUL RIQUAZA ZAVAHIR MD

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4560 ADMIRALTY WAY STE 100
MARINA DEL REY CA
90292-5424
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-656-1770
  • Fax:
Mailing address:
  • Phone: 310-301-8707
  • Fax: 310-301-8751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA 95708
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: