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General NPI Number Information
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NPI Number | 1568650380
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Entity Type | Individual
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Provider Name | FRED MARK RARICK M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/05/2007
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Last Update Date | 10/05/2007
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Provider Practice Location Address
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Address Line | 13 PINTO LN
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City | PALOS VERDES ESTATES
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State | CA
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Zip | 90274-4121
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Country | US
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Telephone | 310-377-2821
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Fax | 310-377-2821
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Provider Business Mailing Address
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Address Line | 13 PINTO LANE
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City | ROLLING HILLS EST.ATE
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State | CA
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Zip | 90274
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Country | US
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Telephone | 310-377-2821
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Fax | 310-377-2821
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | G4106
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License Number State | CA
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