Healthcare Provider Details

I. General information

NPI: 1003065707
Provider Name (Legal Business Name): MARTHA RICCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6621 SOUTHWIND DR
EL PASO TX
79912
US

IV. Provider business mailing address

6621 SOUTHWIND DR
EL PASO TX
79912-3236
US

V. Phone/Fax

Practice location:
  • Phone: 915-584-2048
  • Fax:
Mailing address:
  • Phone: 915-584-2048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number001000618
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: