Provider Demographics
NPI:1649625146
Name:MOLLAH, RIZWANA (MD)
Entity type:Individual
Prefix:DR
First Name:RIZWANA
Middle Name:
Last Name:MOLLAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 PARADISE RD
Mailing Address - Street 2:STE E
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351-3163
Mailing Address - Country:US
Mailing Address - Phone:209-342-3170
Mailing Address - Fax:
Practice Address - Street 1:401 PARADISE RD
Practice Address - Street 2:STE E
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-3163
Practice Address - Country:US
Practice Address - Phone:209-342-3170
Practice Address - Fax:209-576-3597
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA151464207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine