Healthcare Provider Details

I. General information

NPI: 1669543096
Provider Name (Legal Business Name): JENNIFER MARIA RIZZOLI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MDOS SGOE 101 BODIN CIR
TRAVIS AFB CA
94535-1809
US

IV. Provider business mailing address

179 FEATHER RIVER CIR
VACAVILLE CA
95688-8749
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-3826
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35-07-9626R
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: