Healthcare Provider Details

I. General information

NPI: 1932312063
Provider Name (Legal Business Name): RICHARD BRIAN FOULKES M.D,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2446 W WHITTIER BLVD
MONTEBELLO CA
90640-3041
US

IV. Provider business mailing address

6857 CAMROSE DR
LOS ANGELES CA
90068-3100
US

V. Phone/Fax

Practice location:
  • Phone: 323-728-5500
  • Fax: 323-728-4408
Mailing address:
  • Phone: 708-955-5678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036086926
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG85290
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: