Healthcare Provider Details

I. General information

NPI: 1598760092
Provider Name (Legal Business Name): KURT MASON RICHARDS P.A. - C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

7325 MEDICAL CENTER DR SUITE 200
WEST HILLS CA
91307-1925
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-8888
  • Fax:
Mailing address:
  • Phone: 818-981-2050
  • Fax: 818-981-2382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number14778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: