Provider Demographics
NPI:1053437939
Name:RIZAL, INDIRA (MS)
Entity type:Individual
Prefix:MS
First Name:INDIRA
Middle Name:
Last Name:RIZAL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 SPRUCE ST
Mailing Address - Street 2:APT 10D
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5657
Mailing Address - Country:US
Mailing Address - Phone:215-545-1218
Mailing Address - Fax:
Practice Address - Street 1:112 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19102-1510
Practice Address - Country:US
Practice Address - Phone:215-568-0860
Practice Address - Fax:215-568-0769
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor