Healthcare Provider Details

I. General information

NPI: 1225059488
Provider Name (Legal Business Name): DAVID J RICKLES M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14608 HAWTHORNE BLVD
LAWNDALE CA
90260-1521
US

IV. Provider business mailing address

2104 ELM AVE
MANHATTAN BEACH CA
90266-2807
US

V. Phone/Fax

Practice location:
  • Phone: 310-978-4970
  • Fax: 310-978-8668
Mailing address:
  • Phone: 310-650-5986
  • Fax: 310-078-8668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License NumberG56693
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID J RICKLES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-650-5986