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Organization
ANGEL ERNESTO RICO MD PA
Active
Organization
ANGEL ERNESTO RICO MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGEL ERNESTO RICO MD PA (PRESIDENT)
(305) 828-3214
Entity
Organization
Contact information
Practice address
15495 EAGLE NEST LN, SUITE # 225, MIAMI LAKES, FL 33014-2266
(305) 828-3214
(305) 828-3216
Mailing address
15495 EAGLE NEST LN, SUITE # 225, MIAMI LAKES, FL 33014-2266
(305) 828-3214
(305) 828-3216
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME98769
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1417166091
IND NPI
FL
05
—
278704100
—
FL
01
—
ME98769
FL LICENSE
FL
Enumeration date
11/17/2011
Last updated
11/17/2011
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