Healthcare Provider Details

I. General information

NPI: 1629421797
Provider Name (Legal Business Name): RIAZ MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 SPRING RIDGE DR
SUSANVILLE CA
96130-6100
US

IV. Provider business mailing address

1921 ANNA AVE
RICHLAND WA
99352-9521
US

V. Phone/Fax

Practice location:
  • Phone: 702-453-3799
  • Fax: 702-453-5741
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA127480
License Number StateCA

VIII. Authorized Official

Name: MUHAMMAD RIAZ
Title or Position: SOLE OWNER
Credential: M.D.
Phone: 805-704-7910