Provider Demographics
NPI:1437932720
Name:NASSIF DE RICO, OZIEL (NP)
Entity Type:Individual
Prefix:
First Name:OZIEL
Middle Name:
Last Name:NASSIF DE RICO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:OZIEL
Other - Middle Name:
Other - Last Name:NASSIF RUDAMETKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, NP
Mailing Address - Street 1:412 4TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUSA
Mailing Address - State:CA
Mailing Address - Zip Code:95932-2602
Mailing Address - Country:US
Mailing Address - Phone:707-732-8679
Mailing Address - Fax:707-261-9113
Practice Address - Street 1:412 4TH ST
Practice Address - Street 2:
Practice Address - City:COLUSA
Practice Address - State:CA
Practice Address - Zip Code:95932-2602
Practice Address - Country:US
Practice Address - Phone:707-732-8679
Practice Address - Fax:707-261-9113
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026031363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily