Provider Demographics
NPI:1194744680
Name:RACZKA, RICHARD CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CHARLES
Last Name:RACZKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11190 WARNER AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4045
Mailing Address - Country:US
Mailing Address - Phone:714-241-7000
Mailing Address - Fax:714-241-7003
Practice Address - Street 1:11190 WARNER AVE STE 300
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4045
Practice Address - Country:US
Practice Address - Phone:714-241-7000
Practice Address - Fax:714-241-7003
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34092207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A340920Medicaid
CAA34092OtherMEDICAL LICENSE
CAAR8789933OtherDEA REGISTRATION NUMBER
CAA34092OtherMEDICAL LICENSE