Provider Demographics
NPI:1073722369
Name:VICENTE, RIZALINO G (MD)
Entity Type:Individual
Prefix:MR
First Name:RIZALINO
Middle Name:G
Last Name:VICENTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7544 LAUREL CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-3148
Mailing Address - Country:US
Mailing Address - Phone:818-691-3260
Mailing Address - Fax:818-691-3293
Practice Address - Street 1:7544 LAUREL CANYON BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-3148
Practice Address - Country:US
Practice Address - Phone:818-691-3260
Practice Address - Fax:818-691-3293
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA34431207Q00000X
CAA034431207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6120424Medicare UPIN
CAWA84627Medicare Oscar/Certification
CAA84627Medicare UPIN