Healthcare Provider Details

I. General information

NPI: 1639029853
Provider Name (Legal Business Name): NAZIMUDDIN ACHICZY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7172 MAGNOLIA AVE
RIVERSIDE CA
92504-3804
US

IV. Provider business mailing address

7172 MAGNOLIA AVE
RIVERSIDE CA
92504-3804
US

V. Phone/Fax

Practice location:
  • Phone: 951-788-2224
  • Fax: 951-788-5190
Mailing address:
  • Phone:
  • Fax: 951-788-5190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: