Provider Demographics
NPI:1629369327
Name:RIZZOTTO, SAMMY
Entity Type:Individual
Prefix:
First Name:SAMMY
Middle Name:
Last Name:RIZZOTTO
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 1:1103 W ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-2443
Mailing Address - Country:US
Mailing Address - Phone:254-773-1226
Mailing Address - Fax:254-773-1227
Practice Address - Street 1:1103 W ADAMS AVE
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-2443
Practice Address - Country:US
Practice Address - Phone:254-773-1226
Practice Address - Fax:254-773-1227
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4043247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140634003Medicaid
TX140634002Medicaid
TX140634001Medicaid
TX140634003Medicaid