Provider Demographics
NPI:1235227778
Name:RICHARDS, JAMES MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MARTIN
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6222 W MANCHESTER AVE
Mailing Address - Street 2:STE A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3801
Mailing Address - Country:US
Mailing Address - Phone:310-670-1840
Mailing Address - Fax:310-670-4016
Practice Address - Street 1:6222 W MANCHESTER AVE
Practice Address - Street 2:STE A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3801
Practice Address - Country:US
Practice Address - Phone:310-670-1840
Practice Address - Fax:310-670-4016
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37794174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0080020Medicaid
CAGR0080020Medicaid
CAW14127Medicare ID - Type Unspecified