Healthcare Provider Details

I. General information

NPI: 1194774158
Provider Name (Legal Business Name): RICHARD ERIC JAMES MADRID M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30420 HAUN RD
MENIFEE CA
92584-6810
US

IV. Provider business mailing address

28780 SINGLE OAK DR., SUITE 160
TEMECULA CA
92590-5528
US

V. Phone/Fax

Practice location:
  • Phone: 951-676-4193
  • Fax:
Mailing address:
  • Phone: 951-676-4193
  • Fax: 951-719-1469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA84715
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: