Provider Demographics
NPI:1891140265
Name:RAZAVI, ROSHAN (DO)
Entity Type:Individual
Prefix:
First Name:ROSHAN
Middle Name:
Last Name:RAZAVI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:ROASHAN
Other - Middle Name:
Other - Last Name:RAZAVI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:200 HAWKINS DR.
Mailing Address - Street 2:DEPT OF FAMILY MEDICINE
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:760-975-1239
Mailing Address - Fax:
Practice Address - Street 1:1117 DEVONSHIRE AVE
Practice Address - Street 2:ATTN: CAROL WOOD, GME OFFICE, HEMET VALLEY MEDICAL CENT
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543
Practice Address - Country:US
Practice Address - Phone:760-975-1239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-11066207Q00000X
CAB5147164208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine