Provider Demographics
NPI:1518626506
Name:DERRICO, XAVIER RICARDO
Entity Type:Individual
Prefix:
First Name:XAVIER
Middle Name:RICARDO
Last Name:DERRICO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 BADER AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-5239
Mailing Address - Country:US
Mailing Address - Phone:216-326-8940
Mailing Address - Fax:
Practice Address - Street 1:4501 BADER AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-5239
Practice Address - Country:US
Practice Address - Phone:216-326-8940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty