MEDICARE: YALILI RIZO MA59274

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MA59274	FL

General Provider Information

NPI Number	:	1073815759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YALILI RIZO MA59274

Provider Business Mailing Address
First Line	:	6607 BLOSSOM AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-3864
Country	:	US
Telephone Number	:	813-451-0032
Fax Number	:

Provider Business Practice Location Address
First Line	:	6607 BLOSSOM AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-3864
Country	:	US
Telephone Number	:	813-451-0032
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2010
Last Update Date	:	12/01/2010

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Directions to “ YALILI RIZO MA59274” Practice Location

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