Provider Demographics
NPI:1992187421
Name:IZZO, AGNESE
Entity Type:Individual
Prefix:
First Name:AGNESE
Middle Name:
Last Name:IZZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANI
Other - Middle Name:
Other - Last Name:IZZO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1410 COLUMBIA RD
Mailing Address - Street 2:SOUTH BOSTON
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-4019
Mailing Address - Country:US
Mailing Address - Phone:860-966-5640
Mailing Address - Fax:
Practice Address - Street 1:1970 FAIRWAY OAKS DR
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:CA
Practice Address - Zip Code:95366-9360
Practice Address - Country:US
Practice Address - Phone:209-345-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-20
Last Update Date:2015-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic