Healthcare Provider Details

I. General information

NPI: 1316234693
Provider Name (Legal Business Name): NAYEF MOHAMMED A. KAZZAZ M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6180 BROCKTON AVE STE 204
RIVERSIDE CA
92506-2233
US

IV. Provider business mailing address

6180 BROCKTON AVE STE 204
RIVERSIDE CA
92506-2233
US

V. Phone/Fax

Practice location:
  • Phone: 951-781-7700
  • Fax: 951-781-0313
Mailing address:
  • Phone: 951-781-7700
  • Fax: 951-781-0313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number51325
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number51325
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: