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General NPI Number Information
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NPI Number | 1245338342
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Entity Type | Individual
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Provider Name | MARY JOYCE RICO MD
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Gender | Female
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 02/18/2022
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Provider Practice Location Address
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Address Line | 1432 NE 105TH ST
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City | MIAMI SHORES
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State | FL
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Zip | 33138-2114
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Country | US
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Telephone | 224-216-7749
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Fax | 847-835-9946
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Provider Business Mailing Address
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Address Line | 1432 NE 105TH ST
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City | MIAMI SHORES
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State | FL
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Zip | 33138-2114
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Country | US
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Telephone | 224-216-7749
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Fax | 847-835-9946
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 13878
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 30465
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | LL-909
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License Number State | FL
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