MEDICARE: DR. AQUILA RICHARDSON PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY33307	CA

General Provider Information

NPI Number	:	1326182361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AQUILA RICHARDSON PHD

Provider Business Mailing Address
First Line	:	PO BOX 93
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94064-0093
Country	:	US
Telephone Number	:	650-643-3990
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 93
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94064-0093
Country	:	US
Telephone Number	:	650-643-3990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	02/27/2025

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