Provider Demographics
NPI:1700022464
Name:S M HAMMAD RIZVI M D INC
Entity Type:Organization
Organization Name:S M HAMMAD RIZVI M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:M
Authorized Official - Last Name:RIZVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-946-0844
Mailing Address - Street 1:901 SAN BERNARDINO RD STE 104
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4993
Mailing Address - Country:US
Mailing Address - Phone:909-946-0844
Mailing Address - Fax:909-982-4770
Practice Address - Street 1:901 SAN BERNARDINO RD STE 104
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4993
Practice Address - Country:US
Practice Address - Phone:909-946-0844
Practice Address - Fax:909-982-4770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-31
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96440207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty