Provider Demographics
NPI:1750058335
Name:CHAPMAN, RICHARD DARYL ENRIQUEZ
Entity Type:Individual
Prefix:
First Name:RICHARD DARYL
Middle Name:ENRIQUEZ
Last Name:CHAPMAN
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 1:4202 DIYA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-4701
Mailing Address - Country:US
Mailing Address - Phone:415-323-8247
Mailing Address - Fax:
Practice Address - Street 1:4202 DIYA AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-4701
Practice Address - Country:US
Practice Address - Phone:415-323-8247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCNA030128273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000000OtherN/A