Provider Demographics
NPI:1205071073
Name:RIZVI, MURTAZA (MD)
Entity type:Individual
Prefix:DR
First Name:MURTAZA
Middle Name:
Last Name:RIZVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MURTAZA
Other - Middle Name:
Other - Last Name:RIZVI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11645 WILSHIRE BLVD STE 1155
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6807
Mailing Address - Country:US
Mailing Address - Phone:424-293-8861
Mailing Address - Fax:424-293-8864
Practice Address - Street 1:11645 WILSHIRE BLVD STE 1155
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6807
Practice Address - Country:US
Practice Address - Phone:424-293-8861
Practice Address - Fax:424-293-8864
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95879207X00000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACH582XMedicare PIN
CACH582WMedicare UPIN