Provider Demographics
NPI:1346484409
Name:FORTE, RAZIA Y (MD)
Entity Type:Individual
Prefix:DR
First Name:RAZIA
Middle Name:Y
Last Name:FORTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 MICHIGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-2705
Mailing Address - Country:US
Mailing Address - Phone:916-363-8888
Mailing Address - Fax:916-469-2273
Practice Address - Street 1:515 MICHIGAN BLVD
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-2705
Practice Address - Country:US
Practice Address - Phone:916-363-8888
Practice Address - Fax:916-469-2273
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA052906208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A529061Medicaid
CAG13240Medicare UPIN
CA00A529060Medicare PIN