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General NPI Number Information
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NPI Number | 1891140265
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Entity Type | Individual
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Provider Name | ROSHAN RAZAVI DO
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Gender | Male
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Dates
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Enumeration Date | 05/04/2016
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Last Update Date | 09/06/2017
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Provider Practice Location Address
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Address Line | 1117 DEVONSHIRE AVE ATTN: CAROL WOOD, GME OFFICE, HEMET VALLEY MEDICAL CENT
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City | HEMET
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State | CA
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Zip | 92543
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Country | US
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Telephone | 760-975-1239
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Fax |
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Provider Business Mailing Address
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Address Line | 200 HAWKINS DR. DEPT OF FAMILY MEDICINE
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City | IOWA CITY
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State | IA
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Zip | 52242-1009
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Country | US
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Telephone | 760-975-1239
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R-11066
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | B5147164
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License Number State | CA
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