Provider Demographics
NPI:1134633027
Name:RIZKALLA, ALICIA (RN)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:RIZKALLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 MARGUERITA AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-2556
Mailing Address - Country:US
Mailing Address - Phone:808-298-5605
Mailing Address - Fax:
Practice Address - Street 1:ALTAMED PACE
Practice Address - Street 2:1900 SLAUSON STREET
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255
Practice Address - Country:US
Practice Address - Phone:323-597-2844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA562170171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator