Provider Demographics
NPI:1770787665
Name:CARLOS RIZO-PATRON
Entity type:Organization
Organization Name:CARLOS RIZO-PATRON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZO-PATRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-792-3410
Mailing Address - Street 1:PO BOX 94070
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79493-4070
Mailing Address - Country:US
Mailing Address - Phone:806-792-3410
Mailing Address - Fax:806-799-0533
Practice Address - Street 1:3711 22ND ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1303
Practice Address - Country:US
Practice Address - Phone:806-792-3410
Practice Address - Fax:806-799-0533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9303174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty