Provider Demographics
NPI:1134349061
Name:METZNER, RICHARD JOEL (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOEL
Last Name:METZNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:840 LARRABEE ST
Mailing Address - Street 2:#1-319
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4540
Mailing Address - Country:US
Mailing Address - Phone:310-360-0306
Mailing Address - Fax:310-360-0309
Practice Address - Street 1:840 LARRABEE ST
Practice Address - Street 2:#1-319
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-4540
Practice Address - Country:US
Practice Address - Phone:310-360-0306
Practice Address - Fax:310-360-0309
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG165042084P0800X
AZ249642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABM9603425OtherDEA