Provider Demographics
NPI:1932103595
Name:AHSAN, ADEELA RIZVI (MD)
Entity type:Individual
Prefix:
First Name:ADEELA
Middle Name:RIZVI
Last Name:AHSAN
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 1:4870 BARRANCA PKWY STE 230
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4788
Mailing Address - Country:US
Mailing Address - Phone:949-552-1546
Mailing Address - Fax:866-844-8534
Practice Address - Street 1:4870 BARRANCA PKWY STE 230
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4788
Practice Address - Country:US
Practice Address - Phone:949-552-1546
Practice Address - Fax:866-844-8534
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53946207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH14530Medicare UPIN