Provider Demographics
NPI:1659547297
Name:RICAFRENTE, GARY LAMANGAN
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:LAMANGAN
Last Name:RICAFRENTE
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 1:5250 CLAREMONT AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5700
Mailing Address - Country:US
Mailing Address - Phone:209-644-7000
Mailing Address - Fax:
Practice Address - Street 1:5250 CLAREMONT AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5700
Practice Address - Country:US
Practice Address - Phone:209-644-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-04
Last Update Date:2008-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8J78286343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)