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General NPI Number Information
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NPI Number | 1578654109
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Entity Type | Individual
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Provider Name | MARC RICHMOND M.D
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Gender | Male
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 5502 SOUTHALL TER
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City | IRVINE
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State | CA
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Zip | 92603-3515
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Country | US
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Telephone | 949-466-4651
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Fax | 949-856-3222
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Provider Business Mailing Address
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Address Line | 5502 SOUTHALL TER
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City | IRVINE
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State | CA
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Zip | 92603-3515
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Country | US
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Telephone | 949-466-4651
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Fax | 949-856-3222
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G22621
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | G22621
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License Number State | CA
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