Healthcare Provider Details

I. General information

NPI: 1003755455
Provider Name (Legal Business Name): AYSOUDA MALEKZADEH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 UNIVERSITY AVE. SOM ED. BLDG. II
RIVERSIDE CA
92521
US

IV. Provider business mailing address

900 UNIVERSITY AVE. SOM ED. BLDG. II
RIVERSIDE CA
92521
US

V. Phone/Fax

Practice location:
  • Phone: 951-827-4618
  • Fax: 951-263-7238
Mailing address:
  • Phone: 951-827-4618
  • Fax: 951-263-7238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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: