Healthcare Provider Details

I. General information

NPI: 1366060006
Provider Name (Legal Business Name): RYZEMD CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S MACDILL AVE
TAMPA FL
33609-3532
US

IV. Provider business mailing address

200 S MACDILL AVE
TAMPA FL
33609-3532
US

V. Phone/Fax

Practice location:
  • Phone: 813-353-1268
  • Fax:
Mailing address:
  • Phone: 813-353-1268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WANDA E ESPINOZA-CRUZ
Title or Position: PRESIDENT
Credential: DO
Phone: 813-353-1268