Provider Demographics
NPI:1528698669
Name:DAVID, RICHARD L II
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:L
Last Name:DAVID
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 S DANYELL DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-2630
Mailing Address - Country:US
Mailing Address - Phone:480-445-9377
Mailing Address - Fax:
Practice Address - Street 1:13330 N 88TH PL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-7633
Practice Address - Country:US
Practice Address - Phone:480-445-9377
Practice Address - Fax:480-597-4795
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL11274H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility