| Doctor Name: | DR. RICHARD E MACK |
| NPI Number: | 1023225810 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | G 81683 |
| Business Practice Address: | 16311 Ventura Blvd Suite 1080 Encino, CA - 914362124 |
| Business Phone Number: | 8185015073 |
| Business Fax Number: | |
| Mailing Address: | 16311 Ventura Blvd, Suite 1080 ENCINO |
| State: | CA |
| Postal Code: | 914362124 |
| Phone Number: | 8185015073 |
| Fax Number: | |
| NPI Enumeration Date: | 05/17/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2086S0122X |
| License Number: | G 81683 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Surgery |
| Taxonomy Specialization: | Plastic and Reconstructive Surgery |
| Taxonomy Definition: | A surgeon who specializes in plastic and reconstructive surgery. |