Provider Demographics
NPI:1386827749
Name:HOUSE DOCTORS MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:HOUSE DOCTORS MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TENGIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZNIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-219-1311
Mailing Address - Street 1:PO BOX 51163
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-1163
Mailing Address - Country:US
Mailing Address - Phone:760-219-1311
Mailing Address - Fax:760-862-9126
Practice Address - Street 1:4902 IRVINE CENTER DR
Practice Address - Street 2:SUITE 105
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-3305
Practice Address - Country:US
Practice Address - Phone:949-262-1331
Practice Address - Fax:760-862-9126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-08
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86212208D00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI14856Medicare UPIN