Provider Demographics
NPI:1821281353
Name:ALAMITOS PODIATRY GROUP
Entity Type:Organization
Organization Name:ALAMITOS PODIATRY GROUP
Other - Org Name:DOUGLAS H RICHIE JR D.P.M.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:RICHIE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:562-430-1084
Mailing Address - Street 1:3771 KATELLA AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3108
Mailing Address - Country:US
Mailing Address - Phone:562-430-1084
Mailing Address - Fax:562-430-0886
Practice Address - Street 1:3771 KATELLA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3108
Practice Address - Country:US
Practice Address - Phone:562-430-1084
Practice Address - Fax:562-430-0886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FX753AMedicare PIN
WE11130Medicare PIN