Provider Demographics
NPI:1053666743
Name:HONORATO, RICARDO (PT)
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:
Last Name:HONORATO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6605 KODIAK DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-5901
Mailing Address - Country:US
Mailing Address - Phone:361-288-9828
Mailing Address - Fax:
Practice Address - Street 1:5857 TIMBERGATE DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4237
Practice Address - Country:US
Practice Address - Phone:361-994-0905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1075976314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility