Provider Demographics
NPI:1922396084
Name:RICHARDSON, IRIS (PHD)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2223 E WELLINGTON AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-3161
Mailing Address - Country:US
Mailing Address - Phone:714-558-0303
Mailing Address - Fax:
Practice Address - Street 1:2223 E WELLINGTON AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-3161
Practice Address - Country:US
Practice Address - Phone:714-558-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X, 225400000X
CA26661103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner