Provider Demographics
NPI:1356103766
Name:RICA PEDIATRICS LLC
Entity type:Organization
Organization Name:RICA PEDIATRICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALOTA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:760-201-9400
Mailing Address - Street 1:114 DEBRA DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-1419
Mailing Address - Country:US
Mailing Address - Phone:760-201-9400
Mailing Address - Fax:
Practice Address - Street 1:282 CHOPTANK RD STE 103
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-6481
Practice Address - Country:US
Practice Address - Phone:760-201-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-30
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty