Provider Demographics
NPI:1336117696
Name:DOTSON, RIICO JOSEPH NORIEGA (MD)
Entity Type:Individual
Prefix:
First Name:RIICO
Middle Name:JOSEPH NORIEGA
Last Name:DOTSON
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:PO BOX 8280
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080
Mailing Address - Country:US
Mailing Address - Phone:530-243-7200
Mailing Address - Fax:530-243-7277
Practice Address - Street 1:345 HICKORY ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-2771
Practice Address - Country:US
Practice Address - Phone:530-243-7200
Practice Address - Fax:530-243-7277
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83526207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A835260Medicaid
OOA835260Medicare ID - Type Unspecified
CA00A835260Medicaid
CA6499910002Medicare NSC
CA6602960001Medicare NSC
CA6602960002Medicare NSC
CA6499910001Medicare NSC