Provider Demographics
NPI:1851856819
Name:RICARDO, DANTE JESUS JR (SGT)
Entity Type:Individual
Prefix:MR
First Name:DANTE
Middle Name:JESUS
Last Name:RICARDO
Suffix:JR
Gender:M
Credentials:SGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 FM 1960 RD W APT 1531
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-4125
Mailing Address - Country:US
Mailing Address - Phone:910-750-4597
Mailing Address - Fax:
Practice Address - Street 1:5959 FM 1960 RD W APT 1531
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-4125
Practice Address - Country:US
Practice Address - Phone:910-750-4597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX21820755OtherDRIVERS LICENSE