MEDICARE: JESSICA RIZO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	987654321	OTHER		KAISER

General Provider Information

NPI Number	:	1902491764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA RIZO

Provider Business Mailing Address
First Line	:	2543 BLUE ROCK CT
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95133-2670
Country	:	US
Telephone Number	:	408-613-4236
Fax Number	:

Provider Business Practice Location Address
First Line	:	2543 BLUE ROCK CT
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95133-2670
Country	:	US
Telephone Number	:	408-613-4236
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2021
Last Update Date	:	03/03/2021

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Directions to “ JESSICA RIZO ” Practice Location

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