Provider Demographics
NPI:1962474569
Name:FOX, RICHARD ALAN (NP)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ALAN
Last Name:FOX
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:200 OCEANGATE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4302
Mailing Address - Country:US
Mailing Address - Phone:562-499-6191
Mailing Address - Fax:877-860-2907
Practice Address - Street 1:3946 NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95838-3300
Practice Address - Country:US
Practice Address - Phone:916-564-0521
Practice Address - Fax:877-860-2907
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15441363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01283861/DS9933OtherRAILROAD MEDICARE
CAP01453303-DV5277OtherRAILROAD MEDICARE
CAGA746ZMedicare PIN
CAP01283861/DS9933OtherRAILROAD MEDICARE