Provider Demographics
NPI:1619483468
Name:RIAZ, MISBAH (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:MISBAH
Middle Name:
Last Name:RIAZ
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 DARBY LN
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-9238
Mailing Address - Country:US
Mailing Address - Phone:714-310-5538
Mailing Address - Fax:
Practice Address - Street 1:2003 DARBY LN
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-9238
Practice Address - Country:US
Practice Address - Phone:714-310-5538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-15
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028475163W00000X
TX1134547363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty