MEDICARE: MICHELLE RICO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor

General Provider Information

NPI Number	:	1336113695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE RICO

Provider Business Mailing Address
First Line	:	6288 GOLDEN TRAILS AVE
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91739-9109
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6288 GOLDEN TRAILS AVE
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91739-9109
Country	:	US
Telephone Number	:	909-463-4114
Fax Number	:	909-463-9664

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	07/08/2007

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Directions to “ MICHELLE RICO ” Practice Location

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