Provider Demographics
NPI:1215908702
Name:RIZZO, MARIO W (DPM)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:W
Last Name:RIZZO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ETHAN CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-5456
Mailing Address - Country:US
Mailing Address - Phone:925-284-2504
Mailing Address - Fax:415-681-2042
Practice Address - Street 1:15 W PORTAL AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-1303
Practice Address - Country:US
Practice Address - Phone:415-681-2022
Practice Address - Fax:415-681-2042
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2268213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E22680Medicaid
CA4608790001Medicare NSC
CA000E22680Medicaid