Healthcare Provider Details

I. General information

NPI: 1205972445
Provider Name (Legal Business Name): MR. MARC ALAN RICHMOND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7204 SKYWAY
PARADISE CA
95969
US

IV. Provider business mailing address

7204 SKYWAY
PARADISE CA
95969
US

V. Phone/Fax

Practice location:
  • Phone: 530-872-2103
  • Fax: 530-872-7784
Mailing address:
  • Phone: 530-872-2103
  • Fax: 530-872-7784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: