Healthcare Provider Details

I. General information

NPI: 1659790848
Provider Name (Legal Business Name): RICHARD PEPRAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18800 MAIN ST STE 204
HUNTINGTON BEACH CA
92648-1718
US

IV. Provider business mailing address

18800 MAIN ST STE 204
HUNTINGTON BEACH CA
92648-1718
US

V. Phone/Fax

Practice location:
  • Phone: 949-432-0918
  • Fax: 949-209-2001
Mailing address:
  • Phone: 949-432-0918
  • Fax: 949-209-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberA173173
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: