Healthcare Provider Details

I. General information

NPI: 1679863302
Provider Name (Legal Business Name): RICHARD AYLWARD CP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 HOSPITAL DR SUITE 104B
SACRAMENTO CA
95823-5408
US

IV. Provider business mailing address

PO BOX 45342
SAN FRANCISCO CA
94145-0342
US

V. Phone/Fax

Practice location:
  • Phone: 916-689-7528
  • Fax: 916-689-4428
Mailing address:
  • Phone: 800-726-9180
  • Fax: 800-861-5950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: