Provider Demographics
NPI:1457343576
Name:SECK, RITA MARIA (DO)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:MARIA
Last Name:SECK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:RITA
Other - Middle Name:MARIA
Other - Last Name:BRAECKEVELT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:482 BULLDOG DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89027-3103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 N SANDHILL BLVD
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-4789
Practice Address - Country:US
Practice Address - Phone:702-849-0558
Practice Address - Fax:702-346-2147
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12604208M00000X
NVDO2522207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1743029Medicaid
MI010056150OtherRAILROAD MEDICARE
MI5772254OtherAETNA
MI080B610190OtherBLUE CROSS
MI080B610190OtherBLUE CROSS
MIMI1302Medicare PIN