Provider Demographics
NPI:1528205622
Name:RICHARD, DAVID J (ND)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:RICHARD
Suffix:
Gender:M
Credentials:ND
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:J
Other - Last Name:RICHARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:905 DESSIE PL
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768-2233
Mailing Address - Country:US
Mailing Address - Phone:909-576-9647
Mailing Address - Fax:
Practice Address - Street 1:1645 TRILOGY PKWY
Practice Address - Street 2:
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444-6620
Practice Address - Country:US
Practice Address - Phone:805-343-7520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND339175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath