Healthcare Provider Details

I. General information

NPI: 1003111881
Provider Name (Legal Business Name): RIAMD, INCORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2011
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1534 W 25TH ST
SAN PEDRO CA
90732-4402
US

IV. Provider business mailing address

1534 W 25TH ST
SAN PEDRO CA
90732-4402
US

V. Phone/Fax

Practice location:
  • Phone: 310-547-3034
  • Fax: 310-548-5242
Mailing address:
  • Phone: 310-547-3034
  • Fax: 310-548-5242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA109070
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA109070
License Number StateCA

VIII. Authorized Official

Name: DR. RAMIN ISFAHANI ALIZADEH
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 310-547-3034