Healthcare Provider Details

I. General information

NPI: 1164762621
Provider Name (Legal Business Name): DANIEL RICHMOND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2013
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 S 11TH AVE STE A
YAKIMA WA
98902-3212
US

IV. Provider business mailing address

314 S 11TH AVE STE A
YAKIMA WA
98902-3212
US

V. Phone/Fax

Practice location:
  • Phone: 509-902-8585
  • Fax: 509-902-8030
Mailing address:
  • Phone: 509-902-8585
  • Fax: 509-902-8030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60340765
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA60340765
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: