MEDICARE: ISABEL RICO MD PA

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	208D00000X	General Practice Physician	ME90131	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13102	OTHER	FL	BCBS OF FL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780613869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISABEL RICO MD PA

Provider Business Mailing Address
First Line	:	970 SW 82ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-4271
Country	:	US
Telephone Number	:	305-263-1075
Fax Number	:	305-263-1077

Provider Business Practice Location Address
First Line	:	970 SW 82ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-4271
Country	:	US
Telephone Number	:	305-263-1075
Fax Number	:	305-263-1077

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ISABEL RICO
Credential	:	MD
Telephone Number	:	305-263-1075

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	10/01/2012

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