Healthcare Provider Details

I. General information

NPI: 1073225181
Provider Name (Legal Business Name): THE RIAZ CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2022
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3342 NE 34TH ST
FT LAUDERDALE FL
33308-6906
US

IV. Provider business mailing address

3342 NE 34TH ST
FT LAUDERDALE FL
33308-6906
US

V. Phone/Fax

Practice location:
  • Phone: 954-358-2363
  • Fax: 954-306-2232
Mailing address:
  • Phone: 954-358-2363
  • Fax: 954-306-2232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: AHMED RIAZ
Title or Position: PHYSICIAN
Credential: DO
Phone: 305-495-9560