Healthcare Provider Details

I. General information

NPI: 1164668497
Provider Name (Legal Business Name): LUIS RIZO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2008
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 NW 9TH AVE STE 206
MIAMI FL
33136-1101
US

IV. Provider business mailing address

1801 NW 9TH AVE STE 206
MIAMI FL
33136-1101
US

V. Phone/Fax

Practice location:
  • Phone: 786-466-8490
  • Fax: 305-573-7747
Mailing address:
  • Phone: 786-466-8490
  • Fax: 305-573-6537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME108703
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: