Healthcare Provider Details

I. General information

NPI: 1144310681
Provider Name (Legal Business Name): RICHARD PIETON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RYSZARD PIETON M.D.

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

1253 11TH ST #1
SANTA MONICA CA
90401-2076
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-3711
  • Fax:
Mailing address:
  • Phone: 310-394-1459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA41408
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA41408
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: