Healthcare Provider Details

I. General information

NPI: 1215908702
Provider Name (Legal Business Name): MARIO W. RIZZO D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 W PORTAL AVE
SAN FRANCISCO CA
94127-1303
US

IV. Provider business mailing address

6 ETHAN CT
LAFAYETTE CA
94549-5456
US

V. Phone/Fax

Practice location:
  • Phone: 415-681-2022
  • Fax: 415-681-2042
Mailing address:
  • Phone: 925-284-2504
  • Fax: 415-681-2042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE2268
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: