Provider Demographics
NPI:1295414787
Name:ANGEL ERNESTO RICO MD PA II
Entity type:Organization
Organization Name:ANGEL ERNESTO RICO MD PA II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:ERNESTO
Authorized Official - Last Name:RICO
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:786-353-2098
Mailing Address - Street 1:1275 W 47TH PL STE 420
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3452
Mailing Address - Country:US
Mailing Address - Phone:786-353-2098
Mailing Address - Fax:786-353-2249
Practice Address - Street 1:1275 W 47TH PL STE 420
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3452
Practice Address - Country:US
Practice Address - Phone:863-532-0987
Practice Address - Fax:786-353-2249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-13
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278704100Medicaid