Provider Demographics
NPI:1881662021
Name:FARADAY, RICHARD M (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:FARADAY
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 1:705 W LA VETA AVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4402
Mailing Address - Country:US
Mailing Address - Phone:714-997-5597
Mailing Address - Fax:714-516-2799
Practice Address - Street 1:705 W LA VETA AVE
Practice Address - Street 2:SUITE #114
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4402
Practice Address - Country:US
Practice Address - Phone:714-997-5597
Practice Address - Fax:714-516-2799
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207RI0200X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G707940Medicaid
CA00G707940Medicaid
CA330786938OtherTIN#
CAG07957Medicare UPIN