Provider Demographics
NPI:1215563978
Name:RICO, LESLEY (BACHELOR DEGREE)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:RICO
Suffix:
Gender:F
Credentials:BACHELOR DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12099 W WASHINGTON BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-2622
Mailing Address - Country:US
Mailing Address - Phone:310-751-1171
Mailing Address - Fax:
Practice Address - Street 1:12099 W WASHINGTON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-2622
Practice Address - Country:US
Practice Address - Phone:310-751-1171
Practice Address - Fax:310-751-1171
Is Sole Proprietor?:No
Enumeration Date:2020-03-13
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225400000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7667OtherMEDI-CAL
CA7708OtherMEDI-CAL
CA7368OtherMEDI-CAL
CA7184OtherMEDI-CAL