Provider Demographics
NPI:1699411686
Name:VASQUEZ, RICO RICARDO (LAT)
Entity Type:Individual
Prefix:MR
First Name:RICO
Middle Name:RICARDO
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 IWO JIMA BLVD
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-3627
Mailing Address - Country:US
Mailing Address - Phone:956-376-6815
Mailing Address - Fax:
Practice Address - Street 1:320 IWO JIMA BLVD
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-3627
Practice Address - Country:US
Practice Address - Phone:956-376-6815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT27252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAT2725OtherLICENSE ATHLETIC TRAINER