Healthcare Provider Details

I. General information

NPI: 1073967394
Provider Name (Legal Business Name): MIRNA S RIZKALLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 N LOS COYOTES DIAGONAL STE 112
LONG BEACH CA
90808-3936
US

IV. Provider business mailing address

3320 N LOS COYOTES DIAGONAL STE 112
LONG BEACH CA
90808-3936
US

V. Phone/Fax

Practice location:
  • Phone: 562-517-6970
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA161724
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number207Q00000X
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: