Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E2012 | CA |
Y | 222Z00000X | Podiatrist | E2012 | CA |
NPI | 1013951938 |
---|---|
Provider Name | David James Rizzo |
First Address | Fullerton, CA 92837-0683 |
Second Address | Fullerton, CA 92833-2084 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 26/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E2012 | PODIATRY LICENSE (01) | CA |
T11133 | (02) |