Healthcare Provider Details

I. General information

NPI: 1285218867
Provider Name (Legal Business Name): FNU RIDA UL JANNAT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date: 05/06/2022
Reactivation Date: 07/13/2022

III. Provider practice location address

2023 W VISTA WAY STE J
VISTA CA
92083-6030
US

IV. Provider business mailing address

2023 W VISTA WAY STE J
VISTA CA
92083-6030
US

V. Phone/Fax

Practice location:
  • Phone: 304-435-2709
  • Fax:
Mailing address:
  • Phone: 304-435-2709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA206562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: