Healthcare Provider Details

I. General information

NPI: 1306652078
Provider Name (Legal Business Name): DAVID JUSTIN RICHARDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/09/2024
Certification Date: 12/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44349 LOWTREE AVE
LANCASTER CA
93534-4100
US

IV. Provider business mailing address

962 E 8TH AVE
SPOKANE WA
99202-2457
US

V. Phone/Fax

Practice location:
  • Phone: 661-228-0567
  • Fax: 205-509-5377
Mailing address:
  • Phone: 661-618-6148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: