Provider Demographics
NPI:1407246408
Name:RICHARD GUEST MD, A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:RICHARD GUEST MD, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:GUEST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-507-5099
Mailing Address - Street 1:PO BOX 12325
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91224-5325
Mailing Address - Country:US
Mailing Address - Phone:310-507-5099
Mailing Address - Fax:
Practice Address - Street 1:15478 DUOMO VIA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90077-1515
Practice Address - Country:US
Practice Address - Phone:310-507-5099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA336852086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty