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General NPI Number Information
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NPI Number | 1225059488
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Entity Type | Organization
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Legal Business Name | DAVID J RICKLES M.D. INC.
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 03/05/2012
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Provider Practice Location Address
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Address Line | 14608 HAWTHORNE BLVD
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City | LAWNDALE
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State | CA
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Zip | 90260-1521
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Country | US
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Telephone | 310-978-4970
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Fax | 310-978-8668
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Provider Business Mailing Address
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Address Line | 2104 ELM AVE
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-2807
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Country | US
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Telephone | 310-650-5986
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Fax | 310-078-8668
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID J RICKLES
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Credential | M.D.
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Telephone | 310-650-5986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0203X
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Taxonomy Name | Radiation Oncology Clinic/Center
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License Number | G56693
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License Number State | CA
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