Healthcare Provider Details

I. General information

NPI: 1871865816
Provider Name (Legal Business Name): LAURA RICHARDSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 HERNDON AVE
CLOVIS CA
93611-6800
US

IV. Provider business mailing address

7370 N PALM AVE
FRESNO CA
93711-5782
US

V. Phone/Fax

Practice location:
  • Phone: 559-259-3152
  • Fax:
Mailing address:
  • Phone: 559-228-4222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number20A12435
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: