Organization
TIMOTHY F. RICHARDSON, M.D., A MEDICAL CORPORATION
Active
Other names
Mirage Dermatology Medical Associates, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY RICHARDSON M.D. (PRESIDENT)
(760) 341-1999
Entity
Organization
Contact information
Practice address
36867 COOK ST, SUITE 101, PALM DESERT, CA 92211-6064
(760) 341-1999
(760) 341-1997
Mailing address
PO BOX 1486, RANCHO MIRAGE, CA 92270-1049
(760) 341-1999
(760) 341-1997
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
G53073
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ23174Z
MEDICARE PTAN
CA
Enumeration date
07/25/2006
Last updated
06/28/2021
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