Basic Information
| Provider Information | |||||||||
| NPI: | 1396223012 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIZO | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | MARISSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5849 CROCKER ST UNIT L | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900031311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232344445 | ||||||||
| FaxNumber: | 3232344477 | ||||||||
| Practice Location | |||||||||
| Address1: | 5849 CROCKER ST UNIT L | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900031311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232344445 | ||||||||
| FaxNumber: | 3232344477 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2018 | ||||||||
| LastUpdateDate: | 09/19/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 5414 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.