Provider Demographics
NPI:1003111881
Name:RIAMD, INCORPORATION
Entity Type:Organization
Organization Name:RIAMD, INCORPORATION
Other - Org Name:RAMIN ALIZADEH MD
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMIN
Authorized Official - Middle Name:ISFAHANI
Authorized Official - Last Name:ALIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-547-3034
Mailing Address - Street 1:1534 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-4402
Mailing Address - Country:US
Mailing Address - Phone:310-547-3034
Mailing Address - Fax:310-548-5242
Practice Address - Street 1:1534 W 25TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-4402
Practice Address - Country:US
Practice Address - Phone:310-547-3034
Practice Address - Fax:310-548-5242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109070207R00000X, 2081N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACG060ZMedicare PIN