Individual provider Active NPI

Regina Rico, RN

  • Psychiatric/Mental Health Nurse Practitioner
  • Glendora, CA
National Provider Identifier
1861063463
Registry record updated Feb 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
NP14107 Issued in CA
Practice address
415 W Route 66 Ste 202
Glendora, CA 91740-4335
Phone
(626) 815-6016
NPI assigned
Jul 6, 2021
Last updated
Feb 3, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 3, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NP14107 CA Primary
Continuing Education/Staff Development Registered Nurse 163WC1600X 476769 CA

Addresses

Primary practice location

415 W Route 66 Ste 202
Glendora, CA 91740-4335

Mailing address

645 S Vecino Dr
Covina, CA 91723-3663
Phone (626) 261-3091

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240202002059 CA Practitioner - Nurse Practitioner 4981057270

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
14107CAMDMental Health Counselor
476769CAMDContinuing Education/Staff Development Registered Nurse
NP14107CAMDPsychiatric/Mental Health Nurse Practitioner

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1625529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675382400000",
    "number": "1861063463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 S VECINO DR",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917233663",
            "telephone_number": "626-261-3091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 W ROUTE 66 STE 202",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917404335",
            "telephone_number": "626-815-6016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICO",
        "first_name": "REGINA",
        "name_prefix": "Dr.",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-06",
        "last_updated": "2023-02-03",
        "certification_date": "2023-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "NP14107",
            "primary": true
        },
        {
            "code": "163WC1600X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Continuing Education/Staff Development",
            "state": "CA",
            "license": "476769",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendora, CA

Sources for this page

Verify at the official NPI Registry.