Healthcare Provider Details

I. General information

NPI: 1316801251
Provider Name (Legal Business Name): ANGELIQUE E. RICHARDSON, MD, PHD, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 21ST ST # 13876
SACRAMENTO CA
95811-5226
US

IV. Provider business mailing address

1401 21ST ST # 13876
SACRAMENTO CA
95811-5226
US

V. Phone/Fax

Practice location:
  • Phone: 619-375-4915
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGELIQUE ELLERBEE RICHARDSON
Title or Position: OWNER
Credential: MD
Phone: 619-375-4915