Provider Demographics
NPI:1043324742
Name:RIZKALLA, SUZANNE (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:RIZKALLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25815 BARTON ROAD STE C102
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3857
Mailing Address - Country:US
Mailing Address - Phone:909-478-1100
Mailing Address - Fax:909-478-0618
Practice Address - Street 1:25815 BARTON ROAD STE C102
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3857
Practice Address - Country:US
Practice Address - Phone:909-478-1100
Practice Address - Fax:909-478-0618
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55643207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A556430Medicaid
CA00A556430Medicaid
G44946Medicare UPIN