Provider Demographics
NPI:1659630846
Name:RICHARDSON, EMMETT III
Entity Type:Individual
Prefix:
First Name:EMMETT
Middle Name:
Last Name:RICHARDSON
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4502 44TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-3930
Mailing Address - Country:US
Mailing Address - Phone:916-708-8935
Mailing Address - Fax:
Practice Address - Street 1:4502 44TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-3930
Practice Address - Country:US
Practice Address - Phone:916-708-8935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator