Healthcare Provider Details

I. General information

NPI: 1982700514
Provider Name (Legal Business Name): ROSELAVENDER A. RICHARDS, M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W BUCKEYE RD STE 106
PHOENIX AZ
85003-2648
US

IV. Provider business mailing address

1201 W GOLDFINCH WAY
CHANDLER AZ
85248-3144
US

V. Phone/Fax

Practice location:
  • Phone: 602-258-6997
  • Fax: 602-257-4638
Mailing address:
  • Phone: 480-786-0899
  • Fax: 480-963-1752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number23096
License Number StateAZ

VIII. Authorized Official

Name: ROSELAVENDAR A. RICHARDS
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 602-258-6997