Provider Demographics
NPI:1659838779
Name:MURO, RICKY
Entity Type:Individual
Prefix:MR
First Name:RICKY
Middle Name:
Last Name:MURO
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 1:3303 HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-1530
Mailing Address - Country:US
Mailing Address - Phone:714-786-6069
Mailing Address - Fax:714-834-9822
Practice Address - Street 1:3303 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1530
Practice Address - Country:US
Practice Address - Phone:714-786-6069
Practice Address - Fax:714-834-9822
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2494777106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician