Provider Demographics
NPI:1861049306
Name:RICO, SHIRLEY LEE
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:LEE
Last Name:RICO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5181 STRATFORD AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-1738
Mailing Address - Country:US
Mailing Address - Phone:714-895-3261
Mailing Address - Fax:
Practice Address - Street 1:5181 STRATFORD AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-1738
Practice Address - Country:US
Practice Address - Phone:714-895-3261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider