Healthcare Provider Details

I. General information

NPI: 1932285921
Provider Name (Legal Business Name): RICHARD SEVILLA N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 E MARCH LN
STOCKTON CA
95210-6629
US

IV. Provider business mailing address

1801 E MARCH LN
STOCKTON CA
95210-6629
US

V. Phone/Fax

Practice location:
  • Phone: 209-464-6422
  • Fax: 209-464-0913
Mailing address:
  • Phone: 209-464-6422
  • Fax: 209-464-0913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number495538
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: