Healthcare Provider Details

I. General information

NPI: 1184086639
Provider Name (Legal Business Name): SABA NAWAZISH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 07/21/2022
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6906 BROCKTON AVE STE 6
RIVERSIDE CA
92506-3802
US

IV. Provider business mailing address

12086 CLARK ST APT 202
MORENO VALLEY CA
92557-8667
US

V. Phone/Fax

Practice location:
  • Phone: 951-784-8373
  • Fax: 844-897-3788
Mailing address:
  • Phone: 669-246-8588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA165351
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: