# ANGEL ERNESTO RICO MD PA II

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295414787
- **Authorized official:** ANGEL ERNESTO RICO MD PA (PRESIDENT)
- **Authorized official phone:** (786) 353-2098

## Contact information

- **Practice address:** 1275 W 47TH PL STE 420, HIALEAH, FL 33012-3452
- **Practice address phone:** (863) 532-0987
- **Practice address fax:** (786) 353-2249
- **Mailing address:** 1275 W 47TH PL STE 420, HIALEAH, FL 33012-3452
- **Mailing address phone:** (786) 353-2098
- **Mailing address fax:** (786) 353-2249

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/13/2023
- **Last updated:** 11/09/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 278704100 | — | FL |