Basic Information
| Provider Information | |||||||||
| NPI: | 1194774158 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MADRID | ||||||||
| FirstName: | RICHARD ERIC | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28780 SINGLE OAK DR., SUITE 160 | ||||||||
| Address2: | |||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925905528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516764193 | ||||||||
| FaxNumber: | 9517191469 | ||||||||
| Practice Location | |||||||||
| Address1: | 30420 HAUN RD | ||||||||
| Address2: | |||||||||
| City: | MENIFEE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925846810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516764193 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2006 | ||||||||
| LastUpdateDate: | 02/20/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A84715 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.