Provider Demographics
NPI:1922033430
Name:RIZKALLA, INC.
Entity Type:Organization
Organization Name:RIZKALLA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAFWAT
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZKALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-293-4971
Mailing Address - Street 1:27040 MAIDEN MOOR LN
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-4226
Mailing Address - Country:US
Mailing Address - Phone:714-293-4971
Mailing Address - Fax:714-692-0477
Practice Address - Street 1:17161 GOLDENWEST ST STE C
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-5480
Practice Address - Country:US
Practice Address - Phone:714-373-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ65316ZOtherBLUE SHIELD
CAGR0101670Medicaid
CAGR0101670Medicaid
CAW19205Medicare PIN
CACG983AMedicare PIN