Provider Demographics
NPI:1932116795
Name:RICHARDS, ELIZABETH MARY (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARY
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N PEPPER AVE
Mailing Address - Street 2:DEPT OF FAMILY MEDICINE
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-1801
Mailing Address - Country:US
Mailing Address - Phone:909-580-3370
Mailing Address - Fax:909-580-6308
Practice Address - Street 1:400 N PEPPER AVE
Practice Address - Street 2:ARROWHEAD REGIONAL MEDICAL CENTER
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1819
Practice Address - Country:US
Practice Address - Phone:909-580-6240
Practice Address - Fax:909-580-6308
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37280207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G372800Medicaid
A47024Medicare UPIN
00G372800Medicare ID - Type Unspecified