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General NPI Number Information
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NPI Number | 1659614782
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Entity Type | Organization
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Legal Business Name | RICHARDSON TE MEDICAL GROUP
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Dates
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Enumeration Date | 03/27/2013
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Last Update Date | 03/27/2013
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Provider Practice Location Address
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Address Line | 1127 WILSHIRE BLVD SUITE 1100
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City | LOS ANGELES
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State | CA
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Zip | 90017-4002
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Country | US
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Telephone | 213-977-0511
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Fax | 213-481-2763
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Provider Business Mailing Address
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Address Line | 1127 WILSHIRE BLVD SUITE 1100
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City | LOS ANGELES
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State | CA
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Zip | 90017-4002
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Country | US
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Telephone | 213-977-0511
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Fax | 213-481-2763
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. CAROL ANN RICHARDSON-TE
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Credential | M.D.
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Telephone | 213-977-0511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A89382
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License Number State | CA
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