Provider Demographics
NPI:1528702065
Name:RICHARDSON, DAVIELLE
Entity type:Individual
Prefix:
First Name:DAVIELLE
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 E RAMONA EXPRESSWAY
Mailing Address - Street 2:SUITE 1-3
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571
Mailing Address - Country:US
Mailing Address - Phone:951-349-4195
Mailing Address - Fax:
Practice Address - Street 1:85 E RAMONA EXPRESSWAY
Practice Address - Street 2:SUITE 1-3
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571
Practice Address - Country:US
Practice Address - Phone:951-349-4195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program