Healthcare Provider Details

I. General information

NPI: 1912192881
Provider Name (Legal Business Name): GREGORY G RICHARDSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6709 BROCKTON AVE
RIVERSIDE CA
92506-3023
US

IV. Provider business mailing address

6709 BROCKTON AVE
RIVERSIDE CA
92506-3023
US

V. Phone/Fax

Practice location:
  • Phone: 951-686-2334
  • Fax: 951-369-8500
Mailing address:
  • Phone: 951-686-2334
  • Fax: 951-369-8500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA7089
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: