Provider Demographics
NPI:1245338342
Name:RICO, MARY JOYCE (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JOYCE
Last Name:RICO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1432 NE 105TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2114
Mailing Address - Country:US
Mailing Address - Phone:224-216-7749
Mailing Address - Fax:847-835-9946
Practice Address - Street 1:1432 NE 105TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2114
Practice Address - Country:US
Practice Address - Phone:224-216-7749
Practice Address - Fax:847-835-9946
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC13878207N00000X
NC30465207N00000X
FLLL-909207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology