Healthcare Provider Details

I. General information

NPI: 1619368081
Provider Name (Legal Business Name): RICHARD LESSMAN, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2015
Last Update Date: 02/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 W JANSS RD
THOUSAND OAKS CA
91360-1848
US

IV. Provider business mailing address

227 W JANSS RD
THOUSAND OAKS CA
91360-1848
US

V. Phone/Fax

Practice location:
  • Phone: 805-496-6051
  • Fax: 805-496-6785
Mailing address:
  • Phone: 805-496-6051
  • Fax: 805-496-6785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA23840
License Number StateCA

VIII. Authorized Official

Name: CHARLOTTE JIWANMALL
Title or Position: MANAGER
Credential:
Phone: 805-496-6051