Healthcare Provider Details

I. General information

NPI: 1518022219
Provider Name (Legal Business Name): RITA G. AZZAM CASO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RITA G. AZZAM

II. Dates (important events)

Enumeration Date: 12/25/2006
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 IRON POINT RD
FOLSOM CA
95630-8707
US

IV. Provider business mailing address

3440 KENSINGTON CT
EL DORADO HILLS CA
95762-6913
US

V. Phone/Fax

Practice location:
  • Phone: 916-817-5000
  • Fax:
Mailing address:
  • Phone: 916-933-3985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number20A7936
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: