Healthcare Provider Details

I. General information

NPI: 1538436936
Provider Name (Legal Business Name): MR. VIKTOR RYZHYKH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 S OCEAN DR APT 812
HALLANDALE BEACH FL
33009-4941
US

IV. Provider business mailing address

1833 S OCEAN DR APT 812
HALLANDALE FL
33009
US

V. Phone/Fax

Practice location:
  • Phone: 314-537-5836
  • Fax: 954-919-1480
Mailing address:
  • Phone:
  • Fax: 954-919-1480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberR220877850220
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: