Provider Demographics
NPI:1659614782
Name:RICHARDSON TE MEDICAL GROUP
Entity Type:Organization
Organization Name:RICHARDSON TE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RICHARDSON-TE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-977-0511
Mailing Address - Street 1:1127 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4002
Mailing Address - Country:US
Mailing Address - Phone:213-977-0511
Mailing Address - Fax:213-481-2763
Practice Address - Street 1:1127 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4002
Practice Address - Country:US
Practice Address - Phone:213-977-0511
Practice Address - Fax:213-481-2763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89382207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty