Provider Demographics
NPI:1154169704
Name:RIZVI, MASOOMA (DDS)
Entity type:Individual
Prefix:DR
First Name:MASOOMA
Middle Name:
Last Name:RIZVI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5877 EVENING SKY DR
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-5787
Mailing Address - Country:US
Mailing Address - Phone:818-626-2733
Mailing Address - Fax:
Practice Address - Street 1:5877 EVENING SKY DR
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-5787
Practice Address - Country:US
Practice Address - Phone:818-626-2733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1073441223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty