Provider Demographics
NPI:1235788100
Name:RICO, ERIC J (RC,RB)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:J
Last Name:RICO
Suffix:
Gender:M
Credentials:RC,RB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 MOUNTAIN RD NW STE F2
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87104-1484
Mailing Address - Country:US
Mailing Address - Phone:575-418-1739
Mailing Address - Fax:
Practice Address - Street 1:2001 MOUNTAIN RD NW STE F2
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104-1484
Practice Address - Country:US
Practice Address - Phone:575-418-1739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC044021332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies