Provider Demographics
NPI:1336163328
Name:ESSNER, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:ESSNER
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:15720 VENTURA BLVD STE 227
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2978
Mailing Address - Country:US
Mailing Address - Phone:818-907-7828
Mailing Address - Fax:818-907-6157
Practice Address - Street 1:2121 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2303
Practice Address - Country:US
Practice Address - Phone:310-829-8317
Practice Address - Fax:310-582-7236
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG61190208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF31918Medicare UPIN