Provider Demographics
NPI:1447873344
Name:RICO LAB SERVICES
Entity type:Organization
Organization Name:RICO LAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FEDERICO
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MBA, MLS(ASCP)
Authorized Official - Phone:813-419-2934
Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5927
Mailing Address - Country:US
Mailing Address - Phone:813-419-2934
Mailing Address - Fax:
Practice Address - Street 1:601 S HARBOUR ISLAND BLVD STE 109
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-5927
Practice Address - Country:US
Practice Address - Phone:813-419-2934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2020-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory