Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 44997 | CA |
NPI | 1013036177 |
---|---|
Provider Name | Dr. Imran A Rizvi |
First Address | Tracy, CA 95376-3727 |
Second Address | Tracy, CA 95376-3727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 08/07/2007 |