Provider Demographics
NPI:1629477112
Name:RICKARDS, JEANNY (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEANNY
Middle Name:
Last Name:RICKARDS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:JEANNY
Other - Middle Name:
Other - Last Name:CHEUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1512 GREEN OAK RD
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-8740
Mailing Address - Country:US
Mailing Address - Phone:760-580-6733
Mailing Address - Fax:
Practice Address - Street 1:1512 GREEN OAK RD
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-8740
Practice Address - Country:US
Practice Address - Phone:760-580-6733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006657213ES0103X
CAE5662213ES0103X
TX2309213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery