MEDICARE: RICHARD PRECIADO PA-C

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	363AM0700X	Medical Physician Assistant	PA16627	CA

General Provider Information

NPI Number	:	1548263932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD PRECIADO PA-C

Provider Business Mailing Address
First Line	:	PO BOX 31309
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90031-0309
Country	:	US
Telephone Number	:	323-865-3700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1516 SAN PABLO ST FL 5
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-5313
Country	:	US
Telephone Number	:	323-865-3700
Fax Number	:

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	10/27/2023

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