Provider Demographics
NPI:1609850080
Name:RICKARDS, ENASS ESKANDER (MD)
Entity Type:Individual
Prefix:
First Name:ENASS
Middle Name:ESKANDER
Last Name:RICKARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 LA JOLLA VILLAGE DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-9121
Mailing Address - Country:US
Mailing Address - Phone:858-455-6460
Mailing Address - Fax:858-455-7197
Practice Address - Street 1:4130 LA JOLLA VILLAGE DR
Practice Address - Street 2:SUITE 306
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-9121
Practice Address - Country:US
Practice Address - Phone:858-455-6460
Practice Address - Fax:858-455-7197
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79785207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH01920Medicare UPIN