Basic Information
| Provider Information | |||||||||
| NPI: | 1619368081 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RICHARD LESSMAN, M.D., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 227 W JANSS RD | ||||||||
| Address2: | |||||||||
| City: | THOUSAND OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913601848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054966051 | ||||||||
| FaxNumber: | 8054966785 | ||||||||
| Practice Location | |||||||||
| Address1: | 227 W JANSS RD | ||||||||
| Address2: | |||||||||
| City: | THOUSAND OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913601848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054966051 | ||||||||
| FaxNumber: | 8054966785 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2015 | ||||||||
| LastUpdateDate: | 02/06/2015 | ||||||||
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| AuthorizedOfficialLastName: | JIWANMALL | ||||||||
| AuthorizedOfficialFirstName: | CHARLOTTE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8054966051 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | A23840 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 00A23840 | 05 | CA | MEDICAID |