Healthcare Provider Details

I. General information

NPI: 1043229453
Provider Name (Legal Business Name): MOSEN ISTWANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3595 VAN BUREN BLVD SUITE 203
RIVERSIDE CA
92503-0311
US

IV. Provider business mailing address

3595 VAN BUREN BLVD SUITE 203
RIVERSIDE CA
92503-0311
US

V. Phone/Fax

Practice location:
  • Phone: 951-343-1978
  • Fax: 951-343-1922
Mailing address:
  • Phone: 951-343-1978
  • Fax: 951-343-1922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA64871
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: