Healthcare Provider Details

I. General information

NPI: 1588227946
Provider Name (Legal Business Name): DIYAN M RAZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2019
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 17TH AVE FL 5
SEATTLE WA
98122-5788
US

IV. Provider business mailing address

908 SW 113TH WAY
PEMBROKE PINES FL
33025-3710
US

V. Phone/Fax

Practice location:
  • Phone: 206-320-2800
  • Fax: 206-320-2827
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD61430849
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME159150
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number61430849
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA193332
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: