MEDICARE: DR. ROBER RAAFAT AZIZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	25MA11322200	NJ
2	390200000X	Student in an Organized Health Care Education/Training Program
3	2084P0800X	Psychiatry Physician	A178256	CA

General Provider Information

NPI Number	:	1720510357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBER RAAFAT AZIZ M.D.

Provider Business Mailing Address
First Line	:	30 PROSPECT AVE
Second Line	:
City	:	HACKENSACK
State	:	NJ
Zip	:	07601-1915
Country	:	US
Telephone Number	:	551-996-4450
Fax Number	:

Provider Business Practice Location Address
First Line	:	9990 COUNTY FARM RD
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92503-3542
Country	:	US
Telephone Number	:	951-358-4496
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2017
Last Update Date	:	03/23/2026

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