Healthcare Provider Details

I. General information

NPI: 1720067390
Provider Name (Legal Business Name): BRIAN SCOTT RIZZO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16841 N 31ST AVE BLDG 2
PHOENIX AZ
85053-3029
US

IV. Provider business mailing address

24220 N 62ND DR
GLENDALE AZ
85310-2734
US

V. Phone/Fax

Practice location:
  • Phone: 602-843-4844
  • Fax: 602-843-4846
Mailing address:
  • Phone: 623-572-5019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberAZ3597
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: