Provider Demographics
NPI:1417052549
Name:RICHMOND, ANDREW D (BA)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:D
Last Name:RICHMOND
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3427 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4910
Mailing Address - Country:US
Mailing Address - Phone:619-325-3527
Mailing Address - Fax:619-564-8108
Practice Address - Street 1:3427 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4910
Practice Address - Country:US
Practice Address - Phone:619-325-3527
Practice Address - Fax:619-564-8108
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9736Medicare ID - Type UnspecifiedMEDICAL PROVIDER NUMBER