MEDICARE: AGGREY A RIKITO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1417768805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AGGREY A RIKITO

Provider Business Mailing Address
First Line	:	4128 W BUTLER DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-4650
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4128 W BUTLER DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-4650
Country	:	US
Telephone Number	:	480-859-6138
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2025
Last Update Date	:	01/15/2025

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Directions to “ AGGREY A RIKITO ” Practice Location

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