Provider Demographics
NPI:1225059488
Name:DAVID J RICKLES M.D. INC.
Entity Type:Organization
Organization Name:DAVID J RICKLES M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:RICKLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-650-5986
Mailing Address - Street 1:2104 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2807
Mailing Address - Country:US
Mailing Address - Phone:310-650-5986
Mailing Address - Fax:310-078-8668
Practice Address - Street 1:14608 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1521
Practice Address - Country:US
Practice Address - Phone:310-978-4970
Practice Address - Fax:310-978-8668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56693261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW11319Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO.
MTA93450Medicare UPIN