Healthcare Provider Details

I. General information

NPI: 1912731373
Provider Name (Legal Business Name): MRS. DINA RICO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N MAIN ST STE 209
LAS CRUCES NM
88001-1117
US

IV. Provider business mailing address

3273 SUNSET POINT DR
EL PASO TX
79938-5479
US

V. Phone/Fax

Practice location:
  • Phone: 575-525-3980
  • Fax:
Mailing address:
  • Phone: 915-282-5819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number79840
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1167239
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: