Healthcare Provider Details

I. General information

NPI: 1225971260
Provider Name (Legal Business Name): MR. RICHARD RYAN NEPOMUCENO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE
SAN FRANCISCO CA
94110-3594
US

IV. Provider business mailing address

618 FOREST LAKE DR
PACIFICA CA
94044-1704
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-8000
  • Fax:
Mailing address:
  • Phone: 215-272-9374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number565572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: