Provider Demographics
NPI:1245623297
Name:RIZZO, CRYSTAL WHITLOW (PA-C)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:WHITLOW
Last Name:RIZZO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 LENNON LN
Mailing Address - Street 2:STE 250
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-5915
Mailing Address - Country:US
Mailing Address - Phone:925-948-8143
Mailing Address - Fax:925-948-8143
Practice Address - Street 1:2170 E BIDWELL ST
Practice Address - Street 2:#100
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-6465
Practice Address - Country:US
Practice Address - Phone:530-921-3556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-16
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52371363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant