Provider Demographics
NPI:1851314660
Name:RICHLEY, RICHARD C (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:RICHLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 MIDWAY DR
Mailing Address - Street 2:SUITE 2001
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-4923
Mailing Address - Country:US
Mailing Address - Phone:619-226-8871
Mailing Address - Fax:619-226-1456
Practice Address - Street 1:3434 MIDWAY DR
Practice Address - Street 2:SUITE 2001
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4923
Practice Address - Country:US
Practice Address - Phone:619-226-8871
Practice Address - Fax:619-226-1456
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25110174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA198472500OtherUS DEPARTMENT OF LABOR
CA0465980001Medicare NSC
CAA24284Medicare UPIN
CAA25110Medicare PIN