Provider Demographics
NPI:1114319621
Name:SELECT MULTI SPECIALTY MEDICAL CARE
Entity Type:Organization
Organization Name:SELECT MULTI SPECIALTY MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURE
Authorized Official - Prefix:MR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:S
Authorized Official - Last Name:RIZVI
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:714-591-5683
Mailing Address - Street 1:12665 GARDEN GROVE BLVD
Mailing Address - Street 2:203
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1901
Mailing Address - Country:US
Mailing Address - Phone:714-591-5683
Mailing Address - Fax:
Practice Address - Street 1:12665 GARDEN GROVE BLVD
Practice Address - Street 2:203
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1901
Practice Address - Country:US
Practice Address - Phone:714-591-5683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-21
Last Update Date:2015-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC54373291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory