Provider Demographics
NPI:1972683720
Name:WACHSMAN, RICHARD MURRAY (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:MURRAY
Last Name:WACHSMAN
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 1:3252 HOLIDAY CT STE 105
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1807
Mailing Address - Country:US
Mailing Address - Phone:858-453-1145
Mailing Address - Fax:858-453-1796
Practice Address - Street 1:3252 HOLIDAY CT STE 105
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1807
Practice Address - Country:US
Practice Address - Phone:858-453-1145
Practice Address - Fax:858-453-1796
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG262312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG26231Medicare ID - Type Unspecified
A90981Medicare UPIN