# ANGEL ERNESTO RICO MD PA

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

## Provider details

- **NPI number:** 1740557800
- **Authorized official:** ANGEL ERNESTO RICO MD PA (PRESIDENT)
- **Authorized official phone:** (305) 828-3214

## Contact information

- **Practice address:** 15495 EAGLE NEST LN, SUITE \# 225, MIAMI LAKES, FL 33014-2266
- **Practice address phone:** (305) 828-3214
- **Practice address fax:** (305) 828-3216
- **Mailing address:** 15495 EAGLE NEST LN, SUITE \# 225, MIAMI LAKES, FL 33014-2266
- **Mailing address phone:** (305) 828-3214
- **Mailing address fax:** (305) 828-3216

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | ME98769 | FL | Yes |

## Other

- **Enumeration date:** 11/17/2011
- **Last updated:** 11/17/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1417166091 | IND NPI | FL |
| 05 | — | 278704100 | — | FL |
| 01 | — | ME98769 | FL LICENSE | FL |