Provider Demographics
NPI:1689264897
Name:RICHARDS, AVERY HASTINGS (SPECIALIST)
Entity Type:Individual
Prefix:
First Name:AVERY
Middle Name:HASTINGS
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103
Mailing Address - Country:US
Mailing Address - Phone:510-599-6248
Mailing Address - Fax:
Practice Address - Street 1:25 VAN NESS AVENUE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-9410
Practice Address - Country:US
Practice Address - Phone:510-599-6248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker