Provider Demographics
NPI:1932294865
Name:CAIN, RICHARD PHILIP (MD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:PHILIP
Last Name:CAIN
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 1:5525 ETIWANDA AVE
Mailing Address - Street 2:SUITE 217
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356
Mailing Address - Country:US
Mailing Address - Phone:818-344-4800
Mailing Address - Fax:818-344-1043
Practice Address - Street 1:5525 ETIWANDA AVE
Practice Address - Street 2:SUITE 217
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356
Practice Address - Country:US
Practice Address - Phone:818-344-4800
Practice Address - Fax:818-344-1043
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33969207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG33969DOtherMEDICARE ETCPMA ENC
00G339690OtherBLUE SHIELD
CA00G339690Medicaid
1009582001OtherCIGNA
CAWG33969COtherMEDICARE ETCPMA TZ
CAWG33969DOtherMEDICARE ETCPMA ENC
CAG33969Medicare ID - Type Unspecified