Healthcare Provider Details

I. General information

NPI: 1184644858
Provider Name (Legal Business Name): RICHARD LOUIS GARDNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 E GONZALES RD STE 120
OXNARD CA
93036-8212
US

IV. Provider business mailing address

P.O. BOX 719
SOMIS CA
93066
US

V. Phone/Fax

Practice location:
  • Phone: 805-529-1444
  • Fax: 805-484-8642
Mailing address:
  • Phone: 805-529-1444
  • Fax: 805-484-8642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG56202
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberG56202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: