Provider Demographics
NPI:1144569823
Name:RICO, SONNIE (MA)
Entity Type:Individual
Prefix:
First Name:SONNIE
Middle Name:
Last Name:RICO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2827 SW 126TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-2130
Mailing Address - Country:US
Mailing Address - Phone:786-203-0672
Mailing Address - Fax:305-485-5077
Practice Address - Street 1:2827 SW 126TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-2130
Practice Address - Country:US
Practice Address - Phone:786-203-0672
Practice Address - Fax:305-485-5077
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist