Basic Information
| Provider Information | |||||||||
| NPI: | 1154717742 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEATHER RICHARDSON, MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 436 N BEDFORD DR | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902104310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102788590 | ||||||||
| FaxNumber: | 3102788230 | ||||||||
| Practice Location | |||||||||
| Address1: | 436 N BEDFORD DR | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902104310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102788590 | ||||||||
| FaxNumber: | 3102788230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2015 | ||||||||
| LastUpdateDate: | 04/09/2015 | ||||||||
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| AuthorizedOfficialLastName: | RICHARDSON | ||||||||
| AuthorizedOfficialFirstName: | HEATHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | SOLE OWNER AND PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 4043585553 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 132043 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.