Healthcare Provider Details

I. General information

NPI: 1275885725
Provider Name (Legal Business Name): VICTORIA E RIZK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICTORIA E HART PA-C

II. Dates (important events)

Enumeration Date: 10/09/2012
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 S 90TH ST
WEST ALLIS WI
53227-2455
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 414-328-8150
  • Fax:
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3041-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: