Healthcare Provider Details

I. General information

NPI: 1013912054
Provider Name (Legal Business Name): RICHARD ERIC SWENSSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1737
US

IV. Provider business mailing address

3080 BRISTOL ST STE 600
COSTA MESA CA
92626-7341
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-3350
  • Fax: 562-933-3359
Mailing address:
  • Phone: 714-445-0220
  • Fax: 714-445-0245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberC39805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: