Healthcare Provider Details

I. General information

NPI: 1104285998
Provider Name (Legal Business Name): MAIRA RICO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 BLACKER AVE
EL PASO TX
79902-3324
US

IV. Provider business mailing address

5303 50TH ST
LUBBOCK TX
79414-1817
US

V. Phone/Fax

Practice location:
  • Phone: 806-799-8950
  • Fax:
Mailing address:
  • Phone: 806-799-8950
  • Fax: 806-799-8939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number0869
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number80714
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: