Provider Demographics
NPI:1578560413
Name:EHRLICH, RICHARD M (MD, FACS, FAAP)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:EHRLICH
Suffix:
Gender:M
Credentials:MD, FACS, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 UCLA MEDICAL PLZ
Practice Address - Street 2:SUITE 140
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-825-6865
Practice Address - Fax:310-206-5343
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG14024208000000X, 2088P0231X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1578560413Medicaid
CAG14024OtherMEDICAL LICENSE
CAG14024OtherMEDICAL LICENSE
CAAE4826939OtherDEA NUMBER
CAGK012ZMedicare PIN
CAA39151Medicare UPIN