Healthcare Provider Details

I. General information

NPI: 1720021397
Provider Name (Legal Business Name): JATIN N. AMIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3770 ELIZABETH ST
RIVERSIDE CA
92506-2527
US

IV. Provider business mailing address

3770 ELIZABETH ST
RIVERSIDE CA
92506-2527
US

V. Phone/Fax

Practice location:
  • Phone: 951-352-3937
  • Fax: 951-352-2839
Mailing address:
  • Phone: 951-352-3937
  • Fax: 951-352-2839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG82118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: