Provider Demographics
NPI:1962654392
Name:RICO, SOTARA MANALO (DO)
Entity Type:Individual
Prefix:
First Name:SOTARA
Middle Name:MANALO
Last Name:RICO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SOTARA
Other - Middle Name:
Other - Last Name:MANALO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:5253 RIVERSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4151
Mailing Address - Country:US
Mailing Address - Phone:909-464-2845
Mailing Address - Fax:909-464-2848
Practice Address - Street 1:5253 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4151
Practice Address - Country:US
Practice Address - Phone:909-464-2845
Practice Address - Fax:909-464-2848
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10537207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine