Provider Demographics
NPI:1346936440
Name:ANGEL ERNESTO RICO MD PA
Entity Type:Organization
Organization Name:ANGEL ERNESTO RICO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:ERNESTO
Authorized Official - Last Name:RICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-828-3214
Mailing Address - Street 1:1275 W 47TH PL STE 420
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3452
Mailing Address - Country:US
Mailing Address - Phone:305-828-3214
Mailing Address - Fax:305-828-3216
Practice Address - Street 1:1275 W 47TH PL STE 420
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3452
Practice Address - Country:US
Practice Address - Phone:305-828-3214
Practice Address - Fax:305-828-3216
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANGEL ERNESTO RICO MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty