Healthcare Provider Details

I. General information

NPI: 1497452254
Provider Name (Legal Business Name): BHAKTA B RIZAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 02/13/2023
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E TALLMADGE AVE
AKRON OH
44310-2338
US

IV. Provider business mailing address

240 E TALLMADGE AVE
AKRON OH
44310-2338
US

V. Phone/Fax

Practice location:
  • Phone: 360-915-3977
  • Fax:
Mailing address:
  • Phone: 360-915-3977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: