Healthcare Provider Details

I. General information

NPI: 1063161560
Provider Name (Legal Business Name): LUCAS RIZKALLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 N WATERMAN AVE
SAN BERNARDINO CA
92404-4836
US

IV. Provider business mailing address

9350 THE RESORT PKWY UNIT 9911
RANCHO CUCAMONGA CA
91730-9261
US

V. Phone/Fax

Practice location:
  • Phone: 909-883-8711
  • Fax:
Mailing address:
  • Phone: 714-905-4034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA203341
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: