Healthcare Provider Details

I. General information

NPI: 1952314528
Provider Name (Legal Business Name): RICHARD DENNIS FITE CP,O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 BENTON ST 121 VETERANS MEDICAL CTR
LOMA LINDA CA
92357-0001
US

IV. Provider business mailing address

39326 PROSPECT DR
FOREST FALLS CA
92339-9698
US

V. Phone/Fax

Practice location:
  • Phone: 909-825-7084
  • Fax:
Mailing address:
  • Phone: 909-241-3435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCP1389
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCP1386
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberCP1389
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: