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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