Healthcare Provider Details

I. General information

NPI: 1770283962
Provider Name (Legal Business Name): RICKI WORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16800 ASTON STE 175
IRVINE CA
92606-4820
US

IV. Provider business mailing address

511 COFER CT
WALNUT CA
91789-5208
US

V. Phone/Fax

Practice location:
  • Phone: 949-748-8571
  • Fax:
Mailing address:
  • Phone: 909-518-2263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number17957
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: