Healthcare Provider Details

I. General information

NPI: 1619474558
Provider Name (Legal Business Name): SYED NAWAS AHMED DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2018
Last Update Date: 07/16/2024
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 SHERMAN DR
RIVERSIDE CA
92503-4001
US

IV. Provider business mailing address

3838 SHERMAN DR STE 9
RIVERSIDE CA
92503-4001
US

V. Phone/Fax

Practice location:
  • Phone: 951-352-9228
  • Fax:
Mailing address:
  • Phone: 951-253-9228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5746
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: