Provider Demographics
NPI:1114763083
Name:PEREZ-MACIA, RICKY ALEXANDER
Entity type:Individual
Prefix:
First Name:RICKY
Middle Name:ALEXANDER
Last Name:PEREZ-MACIA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 SAM PERRY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4466
Mailing Address - Country:US
Mailing Address - Phone:540-741-2865
Mailing Address - Fax:540-741-2868
Practice Address - Street 1:1101 SAM PERRY BLVD STE 400
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4466
Practice Address - Country:US
Practice Address - Phone:540-741-2865
Practice Address - Fax:540-741-2868
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program