Healthcare Provider Details

I. General information

NPI: 1972600310
Provider Name (Legal Business Name): GLENN H. RICHMOND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 21ST ST
HUNTINGTON BEACH CA
92648-3318
US

IV. Provider business mailing address

613 21ST ST
HUNTINGTON BEACH CA
92648-3318
US

V. Phone/Fax

Practice location:
  • Phone: 714-375-2077
  • Fax: 714-375-2082
Mailing address:
  • Phone: 714-375-2077
  • Fax: 714-375-2082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA46498
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: