Provider Demographics
NPI:1730151648
Name:SKINNER, RICHARD WILLIAM (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WILLIAM
Last Name:SKINNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4017 MORATALLA TER
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2283
Mailing Address - Country:US
Mailing Address - Phone:619-524-5151
Mailing Address - Fax:
Practice Address - Street 1:BRANCH CLINIC MARINE CORPS RECRUIT DEPOT
Practice Address - Street 2:35000 GUADALCANAL AVE
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92140
Practice Address - Country:US
Practice Address - Phone:619-524-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8585208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A8585OtherSTATE LICENCE
CABS8694879OtherDEA NUMBER