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General NPI Number Information
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NPI Number | 1831231034
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Entity Type | Individual
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Provider Name | DOLLY RICAFORT PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 08/13/2013
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Provider Practice Location Address
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Address Line | 525 3RD AVE
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City | CHULA VISTA
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State | CA
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Zip | 91910-5616
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Country | US
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Telephone | 619-585-4050
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Fax |
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Provider Business Mailing Address
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Address Line | 2208 PASADENA CT UNIT 9
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City | CHULA VISTA
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State | CA
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Zip | 91915-2321
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Country | US
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Telephone | 650-278-6492
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA18217
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License Number State | CA
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