Healthcare Provider Details

I. General information

NPI: 1922205269
Provider Name (Legal Business Name): DAVID J RICKLES, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14608 HAWTHORNE BLVD
LAWNDALE CA
90260-1521
US

IV. Provider business mailing address

14608 HAWTHORNE BLVD
LAWNDALE CA
90260-1521
US

V. Phone/Fax

Practice location:
  • Phone: 951-691-5123
  • Fax: 951-691-5156
Mailing address:
  • Phone: 951-691-5123
  • Fax: 951-691-5156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DAVID J RICKLES
Title or Position: PRESIDENT
Credential: MD
Phone: 951-691-5123