Healthcare Provider Details

I. General information

NPI: 1881789196
Provider Name (Legal Business Name): RICHARD GARY FRIEDMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 FOURTH AVE SUITE 650
SAN DIEGO CA
92103-2116
US

IV. Provider business mailing address

4060 FOURTH AVE SUITE 650
SAN DIEGO CA
92103-2116
US

V. Phone/Fax

Practice location:
  • Phone: 619-819-7222
  • Fax: 619-299-5023
Mailing address:
  • Phone: 619-819-7222
  • Fax: 619-299-5023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG03243
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberG03243
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: