Provider Demographics
NPI:1821082447
Name:METZ, RICHARD J (MD FACP)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:METZ
Suffix:
Gender:M
Credentials:MD FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 CENTURY PARK E STE 1611
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2021
Mailing Address - Country:US
Mailing Address - Phone:310-553-3189
Mailing Address - Fax:310-553-2422
Practice Address - Street 1:2080 CENTURY PARK E STE 1611
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2021
Practice Address - Country:US
Practice Address - Phone:310-553-3189
Practice Address - Fax:310-552-0022
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2023-05-22
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
CAG032839207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G328390Medicaid
CAG32839Medicare ID - Type UnspecifiedMEDICARE NUMBER
CA00G328390Medicaid