Healthcare Provider Details

I. General information

NPI: 1063458495
Provider Name (Legal Business Name): RICHARD DAVID DEFELICE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 ALHAMBRA BLVD STE 200
SACRAMENTO CA
95816-6510
US

IV. Provider business mailing address

1300 ETHAN WAY SUITE 600
SACRAMENTO CA
95825-2296
US

V. Phone/Fax

Practice location:
  • Phone: 916-325-1040
  • Fax: 916-669-4100
Mailing address:
  • Phone: 916-679-3590
  • Fax: 916-482-3647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberG47183
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberG47183
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberG47183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: