Provider Demographics
NPI:1518022219
Name:AZZAM CASO, RITA G (DO)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:G
Last Name:AZZAM CASO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:G
Other - Last Name:AZZAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3440 KENSINGTON CT
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-6913
Mailing Address - Country:US
Mailing Address - Phone:916-933-3985
Mailing Address - Fax:
Practice Address - Street 1:2155 IRON POINT RD
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-8707
Practice Address - Country:US
Practice Address - Phone:916-817-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-25
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7936207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine