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General NPI Number Information
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NPI Number | 1619426012
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Entity Type | Individual
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Provider Name | REGINA ELISABETH RICO MSW
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Gender | Female
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Dates
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Enumeration Date | 09/26/2016
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Last Update Date | 09/26/2016
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Provider Practice Location Address
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Address Line | 3881 S WESTERN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90062-1105
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Country | US
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Telephone | 800-340-9005
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Fax |
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Provider Business Mailing Address
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Address Line | 5211 E 27TH ST
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City | LONG BEACH
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State | CA
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Zip | 90815-1208
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Country | US
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Telephone | 562-458-7165
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 68235
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 68235
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License Number State | CA
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