Basic Information
| Provider Information | |||||||||
| NPI: | 1629104526 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUTIKNO-ONG | ||||||||
| FirstName: | RIO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1438 E HOLT AVE | ||||||||
| Address2: | |||||||||
| City: | COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269673213 | ||||||||
| FaxNumber: | 6269183359 | ||||||||
| Practice Location | |||||||||
| Address1: | 420 W SAN BERNARDINO RD | ||||||||
| Address2: | |||||||||
| City: | COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269156293 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | G42729 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.