Provider Demographics
NPI:1851425896
Name:PUENTE, RICARDO ANTONIO
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:ANTONIO
Last Name:PUENTE
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 1:238 S RAMPART BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-1404
Mailing Address - Country:US
Mailing Address - Phone:213-639-2570
Mailing Address - Fax:213-487-3769
Practice Address - Street 1:238 S RAMPART BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-1404
Practice Address - Country:US
Practice Address - Phone:213-639-2570
Practice Address - Fax:213-487-3769
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health