Provider Demographics
NPI:1285417030
Name:RIZAKOS, ANGELA LEASCA (CRNP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LEASCA
Last Name:RIZAKOS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 S HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-5130
Mailing Address - Country:US
Mailing Address - Phone:443-838-8168
Mailing Address - Fax:
Practice Address - Street 1:1792 MERRITT BLVD
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-3212
Practice Address - Country:US
Practice Address - Phone:410-284-1133
Practice Address - Fax:410-284-3371
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR228243208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics