Provider Demographics
NPI:1710088307
Name:RICHARDS, JOHN DOUGLAS
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DOUGLAS
Last Name:RICHARDS
Suffix:
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 1:714 W LODI AVE
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-3429
Mailing Address - Country:US
Mailing Address - Phone:209-327-8677
Mailing Address - Fax:209-333-2139
Practice Address - Street 1:714 W LODI AVE
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3429
Practice Address - Country:US
Practice Address - Phone:209-333-0338
Practice Address - Fax:209-333-2139
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA3625237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA0036250OtherMEDI-CAL PROVIDER #