Provider Demographics
NPI:1750353892
Name:ONOFRE-VASQUEZ, RICKY S (MD)
Entity type:Individual
Prefix:
First Name:RICKY
Middle Name:S
Last Name:ONOFRE-VASQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:16661 AKRON ST
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-2308
Mailing Address - Country:US
Mailing Address - Phone:310-454-6948
Mailing Address - Fax:310-454-6948
Practice Address - Street 1:12099 W WASHINGTON BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5882
Practice Address - Country:US
Practice Address - Phone:310-572-6225
Practice Address - Fax:310-572-1267
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAO48136207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE60202Medicare UPIN