Provider Demographics
NPI:1780752238
Name:RAY, RIZZA P (PA)
Entity type:Individual
Prefix:MRS
First Name:RIZZA
Middle Name:P
Last Name:RAY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:RIZZA
Other - Middle Name:P
Other - Last Name:BULURAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:414 N CAMDEN DR
Mailing Address - Street 2:STE 1100
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4532
Mailing Address - Country:US
Mailing Address - Phone:310-278-3400
Mailing Address - Fax:310-278-1240
Practice Address - Street 1:414 N CAMDEN DR
Practice Address - Street 2:STE 1100
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4532
Practice Address - Country:US
Practice Address - Phone:310-278-3400
Practice Address - Fax:310-278-1240
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18681363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA18681OtherPHYSICIAN ASSISTANT