Provider Demographics
NPI:1497452254
Name:RIZAL, BHAKTA B
Entity Type:Individual
Prefix:
First Name:BHAKTA
Middle Name:B
Last Name:RIZAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 E TALLMADGE AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-2338
Mailing Address - Country:US
Mailing Address - Phone:360-915-3977
Mailing Address - Fax:
Practice Address - Street 1:240 E TALLMADGE AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-2338
Practice Address - Country:US
Practice Address - Phone:360-915-3977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care