Healthcare Provider Details

I. General information

NPI: 1164435202
Provider Name (Legal Business Name): FERDINAND REYES RICO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18310 US HIGHWAY 18
APPLE VALLEY CA
92307-2206
US

IV. Provider business mailing address

18310 US HIGHWAY 18
APPLE VALLEY CA
92307-2206
US

V. Phone/Fax

Practice location:
  • Phone: 760-241-6666
  • Fax: 760-947-5619
Mailing address:
  • Phone: 760-241-6666
  • Fax: 760-947-5619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberN4039
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number238476
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberN4039
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA114111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: