Healthcare Provider Details

I. General information

NPI: 1134170954
Provider Name (Legal Business Name): CHRISTOPHER EDWARD RICCA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 E 8TH AVE
DENVER CO
80220-3802
US

IV. Provider business mailing address

4525 E 8TH AVE
DENVER CO
80220-3802
US

V. Phone/Fax

Practice location:
  • Phone: 303-329-6500
  • Fax: 303-329-9020
Mailing address:
  • Phone: 303-329-6500
  • Fax: 303-329-9020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number37299
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: