Basic Information
| Provider Information | |||||||||
| NPI: | 1508864448 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARAGER | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9610 GRANITE RIDGE DR | ||||||||
| Address2: | SUITE B | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921232684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8588108000 | ||||||||
| FaxNumber: | 8582681911 | ||||||||
| Practice Location | |||||||||
| Address1: | 3300 VISTA WAY | ||||||||
| Address2: | STE B | ||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920563752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609679900 | ||||||||
| FaxNumber: | 7609676769 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2005 | ||||||||
| LastUpdateDate: | 09/18/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | G52074 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | CA156007 | 01 | CA | NO. CALIFORNIA PTAN | OTHER | G52074 | 01 | CA | CA LICENSE | OTHER | CB226114 | 01 | CA | SO. CALIFORNIA PTAN | OTHER |