Provider Demographics
NPI:1356359152
Name:MUJICA, RICARDO A (MD)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:A
Last Name:MUJICA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 KNOX CIR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-4586
Mailing Address - Country:US
Mailing Address - Phone:413-262-6920
Mailing Address - Fax:413-568-2897
Practice Address - Street 1:1132 WESTFIELD ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-3878
Practice Address - Country:US
Practice Address - Phone:413-592-1980
Practice Address - Fax:413-439-0096
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2166412084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ28302OtherBLUE CROSS BLUE SHIELD
MA2090091Medicaid
MA470859OtherTUFTS
MAP00175721OtherRAIL ROAD MEDICARE
MAA35563Medicare ID - Type Unspecified
MA2090091Medicaid