Provider Demographics
NPI:1578533972
Name:HYATT, RICAHRD ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICAHRD
Middle Name:ALLAN
Last Name:HYATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:ALLAN
Other - Last Name:HYATT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:200 OCEANGATE #100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4317
Mailing Address - Country:US
Mailing Address - Phone:562-499-6191
Mailing Address - Fax:702-395-3673
Practice Address - Street 1:2279 E PALMDALE #A
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4909
Practice Address - Country:US
Practice Address - Phone:661-273-8813
Practice Address - Fax:661-273-2105
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA20596207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB172YMedicare PIN
CACB172ZMedicare PIN