Provider Demographics
NPI:1598593139
Name:RICOHERMOSO, LEA M (RN)
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:M
Last Name:RICOHERMOSO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-4320
Mailing Address - Country:US
Mailing Address - Phone:714-598-9983
Mailing Address - Fax:
Practice Address - Street 1:21732 S VERMONT AVE STE 210
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2180
Practice Address - Country:US
Practice Address - Phone:310-781-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA809333163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health