Provider Demographics
NPI:1811498306
Name:RICHARDS, MICHAL DIANE
Entity type:Individual
Prefix:
First Name:MICHAL
Middle Name:DIANE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIKKI
Other - Middle Name:
Other - Last Name:PAIGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10417 WALWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-6504
Mailing Address - Country:US
Mailing Address - Phone:702-708-9544
Mailing Address - Fax:
Practice Address - Street 1:3925 N MARTIN L KING BLVD STE 202
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-7675
Practice Address - Country:US
Practice Address - Phone:702-909-9333
Practice Address - Fax:702-909-9262
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor