Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 34-011306 | OH |
N | 207Q00000X | Family Doctor | 34011306 | OH |
N | 207QA0401X | Family Doctor - Addiction Medicine | 34011306 | OH |
N | 208D00000X | General Practice Physician | 34011306 | OH |
NPI | 1750607388 |
---|---|
Provider Name | Dr. Carlos Luis Rico |
First Address | Orient, OH 43146-9272 |
Second Address | Columbus, OH 43228-1607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2010 |
Last Update Date | 26/12/2017 |