Provider Demographics
NPI:1700981685
Name:MOONEY, RICHARD J (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:MOONEY
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 1:2420 SONOMA ST STE B
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-3027
Mailing Address - Country:US
Mailing Address - Phone:530-246-4455
Mailing Address - Fax:530-229-1148
Practice Address - Street 1:2420 SONOMA ST STE B
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3027
Practice Address - Country:US
Practice Address - Phone:530-246-4455
Practice Address - Fax:530-229-1148
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54430174400000X, 207V00000X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No174400000XOther Service ProvidersSpecialist
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0094810Medicaid
CAZZZ26346ZMedicare ID - Type UnspecifiedGROUP ID
CA00A544300Medicare PIN