Provider Demographics
NPI:1033477179
Name:WHITE, RICARDO DELVIA JR (LPN)
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:DELVIA
Last Name:WHITE
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:MR
Other - First Name:RICARDO
Other - Middle Name:DELVIA
Other - Last Name:WHITE
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:3098 KENSINGTON RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3572
Mailing Address - Country:US
Mailing Address - Phone:216-326-1683
Mailing Address - Fax:
Practice Address - Street 1:3098 KENSINGTON RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44118-3572
Practice Address - Country:US
Practice Address - Phone:216-326-1683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-134120M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse