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General NPI Number Information
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NPI Number | 1922205269
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Entity Type | Organization
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Legal Business Name | DAVID J RICKLES, MD, INC
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 06/17/2008
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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 | 951-691-5123
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Fax | 951-691-5156
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Provider Business Mailing 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 | 951-691-5123
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Fax | 951-691-5156
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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 | MD
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Telephone | 951-691-5123
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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 |
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License Number State |
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