Basic Information
| Provider Information | |||||||||
| NPI: | 1952314528 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FITE | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | DENNIS | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CP,O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39326 PROSPECT DR | ||||||||
| Address2: | |||||||||
| City: | FOREST FALLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923399698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9092413435 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11201 BENTON ST | ||||||||
| Address2: | 121 VETERANS MEDICAL CTR | ||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923570001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098257084 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 224P00000X | CP1386 | CA | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Prosthetist | 225000000X | CP1389 | CA | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Orthotic Fitter | 222Z00000X | CP1389 | CA | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Orthotist |
ID Information
| ID | Type | State | Issuer | Description | CP1389 | 01 | CA | ABC | OTHER |