Provider Demographics
NPI:1407034481
Name:RICHARD P KLIMKOWSKI MD PC
Entity Type:Organization
Organization Name:RICHARD P KLIMKOWSKI MD PC
Other - Org Name:RICHARD P KLIMKOWSKI MD PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:KLIMKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-492-4671
Mailing Address - Street 1:224 DEL MAR
Mailing Address - Street 2:#B
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-4011
Mailing Address - Country:US
Mailing Address - Phone:949-492-4671
Mailing Address - Fax:949-492-4330
Practice Address - Street 1:224 DEL MAR
Practice Address - Street 2:#B
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4011
Practice Address - Country:US
Practice Address - Phone:949-492-4671
Practice Address - Fax:949-492-4330
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICHARD P KLIMKOWSKI MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47143207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty