Provider Demographics
NPI:1306237755
Name:RIZVI, SYED (MANAGER)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:
Last Name:RIZVI
Suffix:
Gender:M
Credentials:MANAGER
Other - Prefix:DR
Other - First Name:AMJAD
Other - Middle Name:A
Other - Last Name:SAFVI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:12665 GARDEN GROVE BLVD STE 204
Mailing Address - Street 2:204
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1916
Mailing Address - Country:US
Mailing Address - Phone:714-768-0090
Mailing Address - Fax:714-768-0090
Practice Address - Street 1:12665 GARDEN GROVE BLVD
Practice Address - Street 2:204
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1901
Practice Address - Country:US
Practice Address - Phone:714-768-0090
Practice Address - Fax:714-768-0090
Is Sole Proprietor?:No
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC54373246QL0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QL0901XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management, Diplomate