Provider Demographics
NPI:1447761796
Name:RIAZ, SAMAR (NMD)
Entity Type:Individual
Prefix:DR
First Name:SAMAR
Middle Name:
Last Name:RIAZ
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 S COUNTRY CLUB DR APT 3110
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-8675
Mailing Address - Country:US
Mailing Address - Phone:714-266-9890
Mailing Address - Fax:
Practice Address - Street 1:2375 E CAMELBACK RD STE 600
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3493
Practice Address - Country:US
Practice Address - Phone:480-508-7050
Practice Address - Fax:855-535-9242
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-13
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17-1665175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath