Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 22756 | CA |
N | 213EG0000X | General Practice | 22756 | CA |
N | 1223P0700X | Prosthodontist | 22756 | CA |
NPI | 1063532299 |
---|---|
Provider Name | Dr. Paul Lee Richardson |
First Address | Loma Linda, CA 92354 |
Second Address | Loma Linda, CA 92354 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
22756 | STATE LICENSE NUMBER (01) | CA |
D22756 | STATE DENTI-CAL NUMBER (01) | CA |