Doctor Name: | DR. JEFFREY C RICKS |
NPI Number: | 1063476752 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 01058306A |
Business Practice Address: | 1200 N State St Lac Usc Medical Center, Nttc, Room 1050 Los Angeles, CA - 900331029 |
Business Phone Number: | 3232264102 |
Business Fax Number: | |
Mailing Address: | 1200 N State St, Lac Usc Medical Center, Nttc, Room 1050 LOS ANGELES |
State: | CA |
Postal Code: | 900331029 |
Phone Number: | 3232264102 |
Fax Number: | |
NPI Enumeration Date: | 04/12/2006 |
NPI Last Update Date: | 05/01/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 01058306A |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IN |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |