Healthcare Provider Details

I. General information

NPI: 1922387158
Provider Name (Legal Business Name): RICHARD MYERS CP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 PARKCOURT PL. BLDG B
SANTA ANA CA
92701-5002
US

IV. Provider business mailing address

12 GOODYEAR STE 130
IRVINE CA
92618-3747
US

V. Phone/Fax

Practice location:
  • Phone: 949-892-5338
  • Fax: 949-419-6478
Mailing address:
  • Phone: 949-892-5338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: