| Juan Carlos Ricaurte Md Inc Pc | |
|
1300 North Vermont Ave, Suite 806 Los Angeles CA 90027-6302 | |
| (323) 663-6790 | |
| (323) 663-6791 |
| Full Name | Juan Carlos Ricaurte Md Inc Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1300 North Vermont Ave, Suite 806, Los Angeles, California |
| Authorized Official Name and Position | Juan Carlos Ricaurte (PRESIDENT) |
| Authorized Official Contact | 6263206303 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Juan Carlos Ricaurte Md Inc Pc 1300 North Vermont Ave, Suite 806 Los Angeles CA 90027-6302 Ph: (323) 663-6790 | Juan Carlos Ricaurte Md Inc Pc 1300 North Vermont Ave, Suite 806 Los Angeles CA 90027-6302 Ph: (323) 663-6790 |
| NPI Number | 1174753040 |
|---|---|
| Provider Enumeration Date | 07/24/2009 |
| Last Update Date | 09/25/2014 |
| Medicare PECOS PAC ID | 5294871307 |
|---|---|
| Medicare Enrollment ID | O20091002000503 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174753040 | NPI | - | NPPES |
| 00A701690 | Medicaid | CA | |
| 1427046341 | Other | CA | INDIVIDUAL PROVIDER NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | A70169 (California) | Primary |
| Provider Name | Juan Ricaurte |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1427046341 PECOS PAC ID: 4486790599 Enrollment ID: I20091002000492 |
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