Provider Demographics
NPI:1487412136
Name:RICO, STEVEN ANTONIO (CHW)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:ANTONIO
Last Name:RICO
Suffix:
Gender:M
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S LA CADENA DR
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3419
Mailing Address - Country:US
Mailing Address - Phone:909-219-5260
Mailing Address - Fax:909-264-3728
Practice Address - Street 1:301 S LA CADENA DR
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3419
Practice Address - Country:US
Practice Address - Phone:909-219-5260
Practice Address - Fax:909-264-3728
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker