Provider Demographics
NPI:1457359812
Name:RECOR, RICHARD DUANE
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DUANE
Last Name:RECOR
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:RICHARD
Other - Middle Name:D
Other - Last Name:RECOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:7700 IRVINE CENTER DR STE 800
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3047
Mailing Address - Country:US
Mailing Address - Phone:949-720-0167
Mailing Address - Fax:
Practice Address - Street 1:7700 IRVINE CENTER DR STE 800
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3047
Practice Address - Country:US
Practice Address - Phone:949-720-0167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11255103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA81-0480655OtherCOMMERCIAL INSURANCE CA
CA810480655OtherBLUE CROSS OF CA ID #
CAOPL112550OtherBLUE SHIELD OF CA
CA810480655OtherCOMMERCIAL INS ID #
CA810480855OtherCOMMERCIAL INSURANCE ID #
CA153614000OtherMAGELLAN BEHAVIORAL HEALT
MT00053230OtherBC BS OF MT
CAOPL112550OtherBLUE SHIELD OF CA