Provider Demographics
NPI:1245563766
Name:RIAZATI, ALEX HABIB (PSYCHOLOGY TRAINEE)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:HABIB
Last Name:RIAZATI
Suffix:
Gender:M
Credentials:PSYCHOLOGY TRAINEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24959 CLIFFROSE ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-8468
Mailing Address - Country:US
Mailing Address - Phone:310-505-9815
Mailing Address - Fax:
Practice Address - Street 1:921 S BEACON ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3740
Practice Address - Country:US
Practice Address - Phone:310-984-3055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor