MEDICARE: MELVIN WOSBELI RICO

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	390200000X	Student in an Organized Health Care Education/Training Program
2	2084P0800X	Psychiatry Physician	PTL12649	CA

General Provider Information

NPI Number	:	1821796764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELVIN WOSBELI RICO

Provider Business Mailing Address
First Line	:	885 TIVERTON DRIVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-0001
Country	:	US
Telephone Number	:	310-825-6373
Fax Number	:

Provider Business Practice Location Address
First Line	:	760 WESTWOOD PLZ STE 37-384
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-5055
Country	:	US
Telephone Number	:	310-825-6373
Fax Number	:

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

Provider Enumeration Date	:	02/20/2023
Last Update Date	:	05/05/2026

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Directions to “ MELVIN WOSBELI RICO ” Practice Location

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