Healthcare Provider Details

I. General information

NPI: 1336163328
Provider Name (Legal Business Name): RICHARD ESSNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 SANTA MONICA BLVD
SANTA MONICA CA
90404-2303
US

IV. Provider business mailing address

15720 VENTURA BLVD STE 227
ENCINO CA
91436-2978
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-8317
  • Fax: 310-582-7236
Mailing address:
  • Phone: 818-907-7828
  • Fax: 818-907-6157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG61190
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberG61190
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: