Provider Demographics
NPI:1740897230
Name:RINCON ROJAS, RICARDO ALBERTO
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:ALBERTO
Last Name:RINCON ROJAS
Suffix:
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 1:9363 FONTAINEBLEAU BLVD APT H109
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5620
Mailing Address - Country:US
Mailing Address - Phone:954-673-5403
Mailing Address - Fax:
Practice Address - Street 1:6303 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4825
Practice Address - Country:US
Practice Address - Phone:786-620-6948
Practice Address - Fax:954-206-0906
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator