Provider Demographics
NPI:1245333145
Name:RICO, ISABEL (MD)
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:
Last Name:RICO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 SW 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4271
Mailing Address - Country:US
Mailing Address - Phone:305-263-1075
Mailing Address - Fax:305-263-1077
Practice Address - Street 1:970 SW 82ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4271
Practice Address - Country:US
Practice Address - Phone:305-263-1075
Practice Address - Fax:305-263-1077
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2013-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90131208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL281267300Medicaid
FL13102OtherBCBS OF FL
FL1159193OtherCOVENTRY
FL281267300Medicaid
FL1159193OtherCOVENTRY