Provider Demographics
NPI:1659249969
Name:PENAMON, RICO LEON
Entity type:Individual
Prefix:
First Name:RICO
Middle Name:LEON
Last Name:PENAMON
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 1:1164 BLADENSBURG RD NE APT 2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-2512
Mailing Address - Country:US
Mailing Address - Phone:202-300-8406
Mailing Address - Fax:
Practice Address - Street 1:1164 BLADENSBURG RD NE APT 2
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-2512
Practice Address - Country:US
Practice Address - Phone:202-300-8406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-28
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty