Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | A67223 | CA |
NPI | 1134175391 |
---|---|
Provider Name | Richard W Swartzentruber |
First Address | Laguna Niguel, CA 92677-4246 |
Second Address | Anaheim, CA 92807-3028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 01/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A672230 | (05) | CA |
H15218 | (02) | CA |