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General NPI Number Information
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NPI Number | 1982700514
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Entity Type | Organization
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Legal Business Name | ROSELAVENDER A. RICHARDS, M.D. P.C.
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 515 W BUCKEYE RD STE 106
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City | PHOENIX
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State | AZ
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Zip | 85003-2648
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Country | US
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Telephone | 602-258-6997
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Fax | 602-257-4638
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Provider Business Mailing Address
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Address Line | 1201 W GOLDFINCH WAY
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City | CHANDLER
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State | AZ
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Zip | 85248-3144
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Country | US
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Telephone | 480-786-0899
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Fax | 480-963-1752
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | ROSELAVENDAR A. RICHARDS
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Credential | M.D.
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Telephone | 602-258-6997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 23096
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License Number State | AZ
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