Provider Demographics
NPI:1780613869
Name:ISABEL RICO MD PA
Entity type:Organization
Organization Name:ISABEL RICO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RICO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-263-1075
Mailing Address - Street 1:970 SW 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4271
Mailing Address - Country:US
Mailing Address - Phone:305-263-1075
Mailing Address - Fax:305-263-1077
Practice Address - Street 1:970 SW 82ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4271
Practice Address - Country:US
Practice Address - Phone:305-263-1075
Practice Address - Fax:305-263-1077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90131208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13102OtherBCBS OF FL
FL281267300Medicaid
FL13102OtherBCBS OF FL