Basic Information
| Provider Information | |||||||||
| NPI: | 1164435202 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICO | ||||||||
| FirstName: | FERDINAND | ||||||||
| MiddleName: | REYES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18310 US HIGHWAY 18 | ||||||||
| Address2: | |||||||||
| City: | APPLE VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923072206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602416666 | ||||||||
| FaxNumber: | 7609475619 | ||||||||
| Practice Location | |||||||||
| Address1: | 18310 US HIGHWAY 18 | ||||||||
| Address2: | |||||||||
| City: | APPLE VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923072206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602416666 | ||||||||
| FaxNumber: | 7609475619 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 10/19/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | N4039 | TX | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 238476 | NY | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | N4039 | TX | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 208600000X | A114111 | CA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 210237808 | 05 | TX | MEDICAID | 0086675 | 05 | OH | MEDICAID | 34383298 | 05 | NM | MEDICAID | 200781200A | 05 | OK | MEDICAID | 210237807 | 05 | TX | MEDICAID |