Healthcare Provider Details

I. General information

NPI: 1477631109
Provider Name (Legal Business Name): PARVEZ S. ISLAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 GIBSON DR SUITE 110
ROSEVILLE CA
95678-5794
US

IV. Provider business mailing address

508 GIBSON DR SUITE 110
ROSEVILLE CA
95678-5794
US

V. Phone/Fax

Practice location:
  • Phone: 916-783-1080
  • Fax: 916-783-1090
Mailing address:
  • Phone: 916-783-1080
  • Fax: 916-783-1090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC51863
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberC51863
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: