Healthcare Provider Details

I. General information

NPI: 1104924323
Provider Name (Legal Business Name): DARA RIZGARI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 FELICITA AVE
SPRING VALLEY CA
91977-5909
US

IV. Provider business mailing address

512 FELICITA AVE
SPRING VALLEY CA
91977-5909
US

V. Phone/Fax

Practice location:
  • Phone: 619-434-2475
  • Fax: 619-434-7678
Mailing address:
  • Phone: 619-434-2475
  • Fax: 619-434-7678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberMTN01230F
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: