Provider Demographics
NPI:1366675571
Name:MASANI, RIYAZ SADRUDDIN (MCS, MBA, LVN)
Entity Type:Individual
Prefix:
First Name:RIYAZ
Middle Name:SADRUDDIN
Last Name:MASANI
Suffix:
Gender:M
Credentials:MCS, MBA, LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 NASSAU LN
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-7320
Mailing Address - Country:US
Mailing Address - Phone:916-459-8686
Mailing Address - Fax:
Practice Address - Street 1:458 DARLINGTON WAY
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-2927
Practice Address - Country:US
Practice Address - Phone:916-459-8686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA237193164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse