1710988563 NPI number — DR. RICHARD KIRK WELSH D.O.

Table of content: DR. RICHARD KIRK WELSH D.O. (NPI 1710988563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710988563 NPI number — DR. RICHARD KIRK WELSH D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WELSH
Provider First Name:
RICHARD
Provider Middle Name:
KIRK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710988563
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41133 MARSEILLE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURRIETA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92562-1976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-677-8187
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH, INC.
Provider Second Line Business Practice Location Address:
11555 1/2 POTRERO RD.
Provider Business Practice Location Address City Name:
BANNING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-849-4761
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/02/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  20A5620 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)