Healthcare Provider Details

I. General information

NPI: 1982975660
Provider Name (Legal Business Name): KAMARR AVIDON WILMINGTON RICHEE M.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KAMARR RICHEE M.C.

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 E 1ST ST
SANTA ANA CA
92705-4007
US

IV. Provider business mailing address

11551 FAYE AVE
GARDEN GROVE CA
92840-1948
US

V. Phone/Fax

Practice location:
  • Phone: 714-542-3581
  • Fax: 714-542-2246
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: