Healthcare Provider Details

I. General information

NPI: 1508417452
Provider Name (Legal Business Name): YVETTE RICO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 MAHLER RD STE 160
BURLINGAME CA
94010-1640
US

IV. Provider business mailing address

PO BOX 981
SEBASTOPOL CA
95473-0981
US

V. Phone/Fax

Practice location:
  • Phone: 650-667-7193
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number33627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: