Provider Demographics
NPI:1295912020
Name:J RONALD RICH MD INC
Entity type:Organization
Organization Name:J RONALD RICH MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-315-3404
Mailing Address - Street 1:2811 WILSHIRE BLVD
Mailing Address - Street 2:#840
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403
Mailing Address - Country:US
Mailing Address - Phone:310-315-3404
Mailing Address - Fax:310-315-3408
Practice Address - Street 1:2811 WILSHIRE BLVD
Practice Address - Street 2:#840
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403
Practice Address - Country:US
Practice Address - Phone:310-315-3404
Practice Address - Fax:310-315-3408
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:J RONALD RICH MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC27997207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA33509Medicare UPIN
CAW4412Medicare PIN