Provider Demographics
NPI:1336170075
Name:RIAZ, HASSAN A (MD)
Entity Type:Individual
Prefix:
First Name:HASSAN
Middle Name:A
Last Name:RIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16444 PARAMOUNT BLVD
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5422
Mailing Address - Country:US
Mailing Address - Phone:562-531-7790
Mailing Address - Fax:562-531-6877
Practice Address - Street 1:16444 PARAMOUNT BLVD
Practice Address - Street 2:SUITE # 103
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5422
Practice Address - Country:US
Practice Address - Phone:562-531-7790
Practice Address - Fax:562-531-6877
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA91582207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A915820Medicaid
CAI49937Medicare UPIN
CA00A915820Medicaid