Provider Demographics
NPI:1013030402
Name:RICO, OSCAR W (MD)
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:W
Last Name:RICO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3619 CLAREMONT ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-3621
Mailing Address - Country:US
Mailing Address - Phone:661-871-8787
Mailing Address - Fax:661-873-8097
Practice Address - Street 1:9001 STOCKDALE HWY
Practice Address - Street 2:28 HC
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-1022
Practice Address - Country:US
Practice Address - Phone:661-654-2395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44703207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE79713Medicare UPIN