Healthcare Provider Details

I. General information

NPI: 1265359368
Provider Name (Legal Business Name): ANTHONY RICCI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

F/T OCEAN ROVER POB 920248
DUTCH HARBOR AK
99692
US

IV. Provider business mailing address

107 LA PLACENTIA
SAN CLEMENTE CA
92672-3817
US

V. Phone/Fax

Practice location:
  • Phone: 951-764-4946
  • Fax:
Mailing address:
  • Phone: 951-764-4946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberP07718
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: