Healthcare Provider Details

I. General information

NPI: 1902472038
Provider Name (Legal Business Name): RICHARD MCDOWELL RADT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2021
Last Update Date: 05/30/2021
Certification Date: 05/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11501 DOLAN AVE
DOWNEY CA
90241-4921
US

IV. Provider business mailing address

11500 PARAMOUNT BLVD
DOWNEY CA
90241-4530
US

V. Phone/Fax

Practice location:
  • Phone: 562-923-7894
  • Fax:
Mailing address:
  • Phone: 562-923-4545
  • Fax: 562-862-5906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: