Healthcare Provider Details

I. General information

NPI: 1124414479
Provider Name (Legal Business Name): ADNAN SYED RAZA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7117 BROCKTON AVE
RIVERSIDE CA
92506-2658
US

IV. Provider business mailing address

7117 BROCKTON AVE
RIVERSIDE CA
92506-2658
US

V. Phone/Fax

Practice location:
  • Phone: 951-782-3720
  • Fax: 951-784-3267
Mailing address:
  • Phone: 951-782-3720
  • Fax: 951-784-3267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number296852
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberA198227
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD7279728
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: