MEDICARE: DR. RICHARD M. EHRLICH MD, FACS, FAAP

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	208000000X	Pediatrics Physician	G14024	CA
2	2088P0231X	Pediatric Urology Physician	G14024	CA
3	208800000X	Urology Physician	G14024	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	G14024	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1578560413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD M. EHRLICH MD, FACS, FAAP

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 UCLA MEDICAL PLZ
Second Line	:	SUITE 140
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-0001
Country	:	US
Telephone Number	:	310-825-6865
Fax Number	:	310-206-5343

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	03/07/2023

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