Healthcare Provider Details

I. General information

NPI: 1508864448
Provider Name (Legal Business Name): RICHARD R BARAGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 09/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 VISTA WAY STE B
OCEANSIDE CA
92056-3752
US

IV. Provider business mailing address

9610 GRANITE RIDGE DR SUITE B
SAN DIEGO CA
92123-2684
US

V. Phone/Fax

Practice location:
  • Phone: 760-967-9900
  • Fax: 760-967-6769
Mailing address:
  • Phone: 858-810-8000
  • Fax: 858-268-1911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberG52074
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: