Mark Rico

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

762067 Issued in CA

Practice address

17593 W Polaris Dr
Goodyear, AZ 85338-5473

Phone

(602) 686-3990

NPI assigned

Dec 9, 2014

Last updated

Dec 9, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1418083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418083200000",
    "number": "1710385612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17593 W POLARIS DR",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853385473",
            "telephone_number": "602-686-3990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17593 W POLARIS DR",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853385473",
            "telephone_number": "602-686-3990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICO",
        "first_name": "MARK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-12-09",
        "last_updated": "2014-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "762067",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA BOARD OF REGISTERED NURSES",
            "identifier": "163W00000X",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ria Flores-Tamayo,D.D.S., Inc.
• Brittany Ricciardi, DPT
• Nicole P Rickman, FNP-C
• Annette Y Ricks, NP
• David Norman Ricks, M.D.
• Molly Rieper
• Trevor Riffey, ATC
• Jarrett Edward Stewart Riley, D.O.
• Alexander J Rinehart, DC, MS, CNS
• Rise Up Recover, LLC (Rise Up Recover)

• Registered Nurse in Goodyear, AZ
• Providers in Goodyear, AZ by specialty
• Registered Nurse in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.