Healthcare Provider Details

I. General information

NPI: 1851787691
Provider Name (Legal Business Name): RICHARDS COSMETIC SURGERY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 04/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 S RAINBOW BLVD BLDG C
LAS VEGAS NV
89118-2545
US

IV. Provider business mailing address

6020 S RAINBOW BLVD BLDG C
LAS VEGAS NV
89118-2545
US

V. Phone/Fax

Practice location:
  • Phone: 702-870-7070
  • Fax: 702-870-0068
Mailing address:
  • Phone: 702-870-7070
  • Fax: 702-870-0068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number15319
License Number StateNV

VIII. Authorized Official

Name: BRYSON RICHARDS
Title or Position: DIRECTOR/PRESIDENT
Credential: M.D.
Phone: 702-870-7070