Basic Information
Provider Information
NPI: 1003000837
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JOHN
FirstName: RICHARD
MiddleName: L
NamePrefix:  
NameSuffix: JR.
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: JOHN
OtherFirstName: RICHARD
OtherMiddleName: L
OtherNamePrefix:  
OtherNameSuffix: JR.
OtherCredential: NP
OtherLastNameType: 2
Mailing Information
Address1: 1550 E. MAIN ST
Address2: MENTAL HEALTH
City: SANTA MARIA
State: CA
PostalCode: 93254
CountryCode: US
TelephoneNumber: 8053546053
FaxNumber:  
Practice Location
Address1: 1550 E MAIN ST
Address2: MENTAL HEALTH
City: SANTA MARIA
State: CA
PostalCode: 934544819
CountryCode: US
TelephoneNumber: 8053546053
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/05/2007
LastUpdateDate: 11/24/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XNPF 13309CAN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363LP0808XNPF 13309CAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsych/Mental Health

No ID Information.


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