| Jean Rizkallah, Md, Inc | |
|
450 Fourth Ave. Ste 408 Chula Vista CA 91910-4430 | |
| (619) 691-1990 | |
| (619) 691-5977 |
| Full Name | Jean Rizkallah, Md, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 450 Fourth Ave., Chula Vista, California |
| Authorized Official Name and Position | Jean Rizkallah (PHYSICIAN/OWNER) |
| Authorized Official Contact | 6196911990 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jean Rizkallah, Md, Inc 450 Fourth Ave. Ste. 408 Chula Vista CA 91910-4430 Ph: (619) 691-1990 | Jean Rizkallah, Md, Inc 450 Fourth Ave. Ste 408 Chula Vista CA 91910-4430 Ph: (619) 691-1990 |
| NPI Number | 1760702237 |
|---|---|
| Provider Enumeration Date | 06/08/2010 |
| Last Update Date | 12/20/2011 |
| Medicare PECOS PAC ID | 9335272830 |
|---|---|
| Medicare Enrollment ID | O20100804000963 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760702237 | NPI | - | NPPES |
| 1003800368 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A93296 (California) | Primary |
| Provider Name | Jean Antoine Rizkallah |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003800368 PECOS PAC ID: 4183705072 Enrollment ID: I20080116000819 |
| Provider Name | Rita E Starritt |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548225964 PECOS PAC ID: 0244222826 Enrollment ID: I20111116000099 |
| Provider Name | Elion Brace |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184890782 PECOS PAC ID: 1052457108 Enrollment ID: I20120106000651 |
| Provider Name | Brittany L Watson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629525340 PECOS PAC ID: 7416235957 Enrollment ID: I20161103000878 |
| Provider Name | Marisa Deptala |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083166615 PECOS PAC ID: 6103180799 Enrollment ID: I20180507002811 |
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