Provider Demographics
NPI:1235841834
Name:RICHARD, IKIYA D
Entity Type:Individual
Prefix:
First Name:IKIYA
Middle Name:D
Last Name:RICHARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6641 E BAYWOOD AVE STE B3
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1723
Mailing Address - Country:US
Mailing Address - Phone:602-921-2562
Mailing Address - Fax:
Practice Address - Street 1:6641 E BAYWOOD AVE STE B3
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1723
Practice Address - Country:US
Practice Address - Phone:602-921-2562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-15
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor