Provider Demographics
NPI:1255499323
Name:RITZO, DALE JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:JOSEPH
Last Name:RITZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S SAN MATEO DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3819
Mailing Address - Country:US
Mailing Address - Phone:650-343-4003
Mailing Address - Fax:650-696-7040
Practice Address - Street 1:101 S SAN MATEO DR
Practice Address - Street 2:SUITE 206
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3819
Practice Address - Country:US
Practice Address - Phone:650-343-4003
Practice Address - Fax:650-696-7040
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50169207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G501690Medicaid
CA00G501690Medicaid
CAA51591Medicare UPIN