Provider Demographics
NPI:1275571374
Name:RIZO, MARIA LUDY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:LUDY
Last Name:RIZO
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 1:437 SW BETHANY DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2136
Mailing Address - Country:US
Mailing Address - Phone:561-344-1775
Mailing Address - Fax:772-344-1786
Practice Address - Street 1:437 SW BETHANY DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2136
Practice Address - Country:US
Practice Address - Phone:772-344-1775
Practice Address - Fax:772-344-1786
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME875782080A0000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275172100Medicaid
NY01744072Medicaid
FL78295OtherBLUE CROSS BLUE SHIELD
FLBT7796052OtherDEA
NY5B9771Medicare ID - Type Unspecified