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NPI Code Detail

MEDICARE: DR. FREDERICK ALLEN RICHBURG II MD

MEDICARE: DR. FREDERICK ALLEN RICHBURG II MD
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
1207QS0010XSports Medicine (Family Medicine) PhysicianA54679CA

General Provider Information

NPI Number : 1881798221
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FREDERICK ALLEN RICHBURG II MD
Provider Business Mailing Address
First Line : 6699 ALVARADO RD
Second Line : SUITE 2100
City : SAN DIEGO
State : CA
Zip : 92120-5238
Country : US
Telephone Number : 619-229-3909
Fax Number : 619-229-3902
Provider Business Practice Location Address
First Line : 4010 SORRENTO VALLEY BLVD
Second Line : SUITE 300
City : SAN DIEGO
State : CA
Zip : 92121-1432
Country : US
Telephone Number : 858-793-7860
Fax Number : 858-436-1289
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2006
Last Update Date : 11/11/2011

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