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Individual
MR. RICKY T BURRESCIA
Active
Individual
MR. RICKY T BURRESCIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00664
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1008402
NCCPA CERTIFICATION
TX
01
—
PA00664
STATE LICENSE
TX
Enumeration date
07/19/2006
Last updated
08/20/2009
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