Healthcare Provider Details

I. General information

NPI: 1023003126
Provider Name (Legal Business Name): PHILIP J. RICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 OAK GROVE RD #200
WALNUT CREEK CA
94598-2536
US

IV. Provider business mailing address

2125 OAK GROVE RD #200
WALNUT CREEK CA
94598-2536
US

V. Phone/Fax

Practice location:
  • Phone: 925-296-7150
  • Fax: 925-296-7171
Mailing address:
  • Phone: 925-296-7150
  • Fax: 925-296-7171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG32089
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: