Healthcare Provider Details

I. General information

NPI: 1245623297
Provider Name (Legal Business Name): CRYSTAL WHITLOW RIZZO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2015
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 E BIDWELL ST #100
FOLSOM CA
95630-6465
US

IV. Provider business mailing address

365 LENNON LN STE 250
WALNUT CREEK CA
94598-5915
US

V. Phone/Fax

Practice location:
  • Phone: 530-921-3556
  • Fax:
Mailing address:
  • Phone: 925-948-8143
  • Fax: 925-948-8143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number52371
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: