Provider Demographics
NPI:1073678009
Name:RICAFORTE, ROMULO R (MD)
Entity Type:Individual
Prefix:
First Name:ROMULO
Middle Name:R
Last Name:RICAFORTE
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 1:361 ELMHURST PL
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3512
Mailing Address - Country:US
Mailing Address - Phone:714-526-4320
Mailing Address - Fax:
Practice Address - Street 1:7128 PACIFIC BLVD # 200
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4776
Practice Address - Country:US
Practice Address - Phone:323-583-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39920207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine