Provider Demographics
NPI:1700354032
Name:LIMON, RICARDO EMMANUEL JR
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:EMMANUEL
Last Name:LIMON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6133 RIVER CROSS DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76114-3159
Mailing Address - Country:US
Mailing Address - Phone:817-637-2823
Mailing Address - Fax:
Practice Address - Street 1:6133 RIVER CROSS DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76114-3159
Practice Address - Country:US
Practice Address - Phone:817-637-2823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant