MEDICARE: PALOMA RIZO

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	2355S0801X	Speech-Language Assistant	35777	TX

General Provider Information

NPI Number	:	1184103079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PALOMA RIZO

Provider Business Mailing Address
First Line	:	500 E STASSNEY LN APT 411
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-3251
Country	:	US
Telephone Number	:	830-422-6776
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 E STASSNEY LN APT 411
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-3251
Country	:	US
Telephone Number	:	830-422-6776
Fax Number	:

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

Provider Enumeration Date	:	08/10/2018
Last Update Date	:	08/10/2018

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Directions to “ PALOMA RIZO ” Practice Location

Language	Start Address	Practice Location

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