Doctor Name: | RICHARD M POWELL |
NPI Number: | 1093707390 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | G27765 |
Business Practice Address: | 5901 W Olympic Blvd Suite 504 Los Angeles, CA - 900364667 |
Business Phone Number: | 3239355858 |
Business Fax Number: | 3239351212 |
Mailing Address: | 5901 W Olympic Blvd, Suite 504 LOS ANGELES |
State: | CA |
Postal Code: | 900364667 |
Phone Number: | 3239355858 |
Fax Number: | 3239351212 |
NPI Enumeration Date: | 08/22/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | G27765 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |