Provider Demographics
NPI:1760623458
Name:RITA R. ARCHER, M.D., INC.
Entity Type:Organization
Organization Name:RITA R. ARCHER, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RITA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ARCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-378-5147
Mailing Address - Street 1:19582 BEACH BLVD STE 219
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-5923
Mailing Address - Country:US
Mailing Address - Phone:714-378-5147
Mailing Address - Fax:714-968-4759
Practice Address - Street 1:19582 BEACH BLVD STE 219
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-5923
Practice Address - Country:US
Practice Address - Phone:714-378-5147
Practice Address - Fax:714-968-4759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85459261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG85459AMedicare UPIN