Provider Demographics
NPI:1336490291
Name:GHODSIZADEH, RITA (LAC)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:
Last Name:GHODSIZADEH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 WATERTON DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-1290
Mailing Address - Country:US
Mailing Address - Phone:614-309-1898
Mailing Address - Fax:
Practice Address - Street 1:6180 LINWORTH RD
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2812
Practice Address - Country:US
Practice Address - Phone:614-848-5211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH000236171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist