Healthcare Provider Details

I. General information

NPI: 1881662021
Provider Name (Legal Business Name): RICHARD M FARADAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 04/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 W LA VETA AVE SUITE #114
ORANGE CA
92868-4402
US

IV. Provider business mailing address

705 W LA VETA AVE SUITE 114
ORANGE CA
92868-4402
US

V. Phone/Fax

Practice location:
  • Phone: 714-997-5597
  • Fax: 714-516-2799
Mailing address:
  • Phone: 714-997-5597
  • Fax: 714-516-2799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number207RI0200X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: