Doctor Name: | MR. VICTOR RICO |
NPI Number: | 1265831630 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 227012244 |
Business Practice Address: | 10 N Virginia St Crystal Lake, IL - 600144139 |
Business Phone Number: | 8154593860 |
Business Fax Number: | |
Mailing Address: | 9419 Creekside Dr, WONDER LAKE |
State: | IL |
Postal Code: | 600977549 |
Phone Number: | 8155272999 |
Fax Number: | |
NPI Enumeration Date: | 08/21/2014 |
NPI Last Update Date: | 08/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 227012244 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |