Provider Demographics
NPI:1417166091
Name:RICO, ANGEL ERNESTO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:ERNESTO
Last Name:RICO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:15495 EAGLE NEST LN
Mailing Address - Street 2:SUITE 225
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2266
Mailing Address - Country:US
Mailing Address - Phone:305-828-3214
Mailing Address - Fax:305-828-3216
Practice Address - Street 1:15495 EAGLE NEST LN
Practice Address - Street 2:SUITE 225
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2266
Practice Address - Country:US
Practice Address - Phone:305-828-3214
Practice Address - Fax:305-828-3216
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2023-07-12
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Provider Licenses
StateLicense IDTaxonomies
FLME 98769208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278704100Medicaid