Provider Demographics
NPI:1730996455
Name:KHAN, RIZWANA ADAM (LVN)
Entity type:Individual
Prefix:
First Name:RIZWANA
Middle Name:ADAM
Last Name:KHAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 ENBORG LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2648
Mailing Address - Country:US
Mailing Address - Phone:408-885-5487
Mailing Address - Fax:
Practice Address - Street 1:6460 NORMANDY DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-1131
Practice Address - Country:US
Practice Address - Phone:408-903-7768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA158586164X00000X
CAVN158685164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty