Healthcare Provider Details

I. General information

NPI: 1336170075
Provider Name (Legal Business Name): HASSAN A RIAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16444 PARAMOUNT BLVD SUITE # 103
PARAMOUNT CA
90723-5422
US

IV. Provider business mailing address

16444 PARAMOUNT BLVD SUITE # 103
PARAMOUNT CA
90723-5422
US

V. Phone/Fax

Practice location:
  • Phone: 562-531-7790
  • Fax: 562-531-6877
Mailing address:
  • Phone: 562-531-7790
  • Fax: 562-531-6877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA91582
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: