Healthcare Provider Details

I. General information

NPI: 1477994911
Provider Name (Legal Business Name): RIZWAN KHALIQ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8305 TORRINGTON AVE
TAMPA FL
33647-1715
US

IV. Provider business mailing address

8305 TORRINGTON AVE
TAMPA FL
33647-1715
US

V. Phone/Fax

Practice location:
  • Phone: 813-748-4373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPSI29827
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: