Healthcare Provider Details

I. General information

NPI: 1366488215
Provider Name (Legal Business Name): RICHARD ARMOUR D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 ALTA AVE SUITE 102
UPLAND CA
91786-2800
US

IV. Provider business mailing address

1113 ALTA AVE SUITE 102
UPLAND CA
91786-2800
US

V. Phone/Fax

Practice location:
  • Phone: 909-981-3311
  • Fax: 909-981-3355
Mailing address:
  • Phone: 909-981-3311
  • Fax: 909-981-3355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A5860
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: