=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770509606
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRAD RICHARD, M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2006
-----------------------------------------------------
Last Update Date | 12/16/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1050 LINDEN AVE
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90813-3321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-491-9000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 210 N TUSTIN AVE
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92705-3807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-883-7243
-----------------------------------------------------
Fax | 714-647-1245
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. BRAD RICHARD
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 800-883-7243
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | C40557
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------