Provider Demographics
NPI:1770601783
Name:HERNANDEZ-RICOFF, BETHZAIDA (MD)
Entity type:Individual
Prefix:DR
First Name:BETHZAIDA
Middle Name:
Last Name:HERNANDEZ-RICOFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3985 BEACON RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5333
Mailing Address - Country:US
Mailing Address - Phone:352-348-7085
Mailing Address - Fax:
Practice Address - Street 1:320 1ST ST NW RM 1054
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20534-0002
Practice Address - Country:US
Practice Address - Phone:352-698-3266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006954208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice