Healthcare Provider Details

I. General information

NPI: 1285417030
Provider Name (Legal Business Name): ANGELA LEASCA RIZAKOS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1792 MERRITT BLVD
DUNDALK MD
21222-3212
US

IV. Provider business mailing address

804 S HIGHLAND AVE
BALTIMORE MD
21224-5130
US

V. Phone/Fax

Practice location:
  • Phone: 410-284-1133
  • Fax: 410-284-3371
Mailing address:
  • Phone: 443-838-8168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR228243
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: