Provider Demographics
NPI:1811772171
Name:RICO, MONIQUA VILLARREAL (CPHT, CHW)
Entity type:Individual
Prefix:
First Name:MONIQUA
Middle Name:VILLARREAL
Last Name:RICO
Suffix:
Gender:F
Credentials:CPHT, CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 TWAIN HARTE CT
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-0957
Mailing Address - Country:US
Mailing Address - Phone:209-201-8870
Mailing Address - Fax:
Practice Address - Street 1:9215 E HIGHWAY 140
Practice Address - Street 2:
Practice Address - City:PLANADA
Practice Address - State:CA
Practice Address - Zip Code:95365-8245
Practice Address - Country:US
Practice Address - Phone:209-382-1291
Practice Address - Fax:209-382-1292
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker