Provider Demographics
NPI:1790912665
Name:RICO, JUAN FELIPE (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:FELIPE
Last Name:RICO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:813-974-2201
Mailing Address - Fax:813-974-2812
Practice Address - Street 1:2 TAMPA GENERAL CIR
Practice Address - Street 2:STC 5TH FLOOR
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3603
Practice Address - Country:US
Practice Address - Phone:813-259-8713
Practice Address - Fax:813-259-8792
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME1146442080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14NT2OtherBLUE CROSS BLUE SHIELD
FL007393400Medicaid
FL007393400Medicaid