Provider Demographics
NPI:1225049406
Name:HAAS, RICHARD BENNETT (DPM)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:BENNETT
Last Name:HAAS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40573 MARGARITA RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-2856
Mailing Address - Country:US
Mailing Address - Phone:951-694-5360
Mailing Address - Fax:951-694-5607
Practice Address - Street 1:28999 OLD TOWN FRONT ST
Practice Address - Street 2:SUITE 205
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5805
Practice Address - Country:US
Practice Address - Phone:951-694-5360
Practice Address - Fax:951-694-5607
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2676213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000E26761Medicare ID - Type Unspecified
CA4446950001Medicare NSC
T19223Medicare UPIN
CA000E26760Medicare PIN