Provider Demographics
NPI:1558788539
Name:SILLER DE LA ROSA, RICARDO ANDRES (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:ANDRES
Last Name:SILLER DE LA ROSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICARDO
Other - Middle Name:ANDRES
Other - Last Name:SILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2929 CALIFORNIA PLZ APT 7123
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-1590
Mailing Address - Country:US
Mailing Address - Phone:956-322-1401
Mailing Address - Fax:
Practice Address - Street 1:42ND AND EMILE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-9168
Practice Address - Country:US
Practice Address - Phone:402-559-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBP10061730OtherMEDICAL LICENSE