Healthcare Provider Details

I. General information

NPI: 1922938372
Provider Name (Legal Business Name): CINDY RICO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 N D ST
SAN BERNARDINO CA
92410-3523
US

IV. Provider business mailing address

1100 N D ST
SAN BERNARDINO CA
92410-3524
US

V. Phone/Fax

Practice location:
  • Phone: 909-888-6956
  • Fax:
Mailing address:
  • Phone: 909-888-6956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRT1441350426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: