Healthcare Provider Details

I. General information

NPI: 1003779778
Provider Name (Legal Business Name): JAMIE RICO ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 PARKWAY DR
LA MESA CA
91942-1534
US

IV. Provider business mailing address

PO BOX 2470
JULIAN CA
92036-2470
US

V. Phone/Fax

Practice location:
  • Phone: 619-303-4344
  • Fax:
Mailing address:
  • Phone: 760-765-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number220110182
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: