Healthcare Provider Details

I. General information

NPI: 1821778770
Provider Name (Legal Business Name): JONATHAN RIZO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 TRUXTUN AVE STE 206
BAKERSFIELD CA
93301-4700
US

IV. Provider business mailing address

2200 ALTURAS DR
BAKERSFIELD CA
93305-2916
US

V. Phone/Fax

Practice location:
  • Phone: 661-932-7243
  • Fax:
Mailing address:
  • Phone: 661-932-7243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4374
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number104053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: