Provider Demographics
NPI:1619036944
Name:METTEL, RICHARD K (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:K
Last Name:METTEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:K
Other - Last Name:METTEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:421 N. RODEO DR PH # 1
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4536
Mailing Address - Country:US
Mailing Address - Phone:310-432-6646
Mailing Address - Fax:310-432-6647
Practice Address - Street 1:421 N. RODEO DR PH # 1
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4536
Practice Address - Country:US
Practice Address - Phone:310-432-6646
Practice Address - Fax:310-432-6647
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG15078207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG15078Medicare ID - Type UnspecifiedMEDICARE ID NUMBER