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General NPI Number Information
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NPI Number | 1760867261
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Entity Type | Individual
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Provider Name | DAVID ALEJANDRO RICO MORA M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/25/2015
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Last Update Date | 07/25/2015
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Provider Practice Location Address
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Address Line | 2799 W GRAND BLVD
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City | DETROIT
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State | MI
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Zip | 48202-2608
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Country | US
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Telephone | 313-916-8445
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Fax | 313-916-9434
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Provider Business Mailing Address
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Address Line | 1118 N CAMPBELL RD APT 221
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City | ROYAL OAK
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State | MI
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Zip | 48067-1541
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Country | US
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Telephone | 786-556-2065
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 4301108009
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License Number State | MI
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