Organization
JUAN CARLOS RICAURTE MD INC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUAN CARLOS RICAURTE M.D. (PRESIDENT)
(626) 320-6303
Entity
Organization
Contact information
Practice address
1300 NORTH VERMONT AVE, SUITE 806, LOS ANGELES, CA 90027-6302
(323) 663-6790
(323) 663-6791
Mailing address
1300 NORTH VERMONT AVE, SUITE 806, LOS ANGELES, CA 90027-6302
(323) 663-6790
(323) 663-6791
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
A70169
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A701690
—
CA
01
—
1427046341
INDIVIDUAL PROVIDER NPI
CA
Enumeration date
07/24/2009
Last updated
09/25/2014
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