Individual
MICHAEL DALE RICHARDSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Contact information
Practice address
HC-83 BLDG 3005, NAVAL HOSPITAL BRANCH CLINIC MCMWTC, BRIDGEPORT, CA 93517-0001
(760) 932-1616
Mailing address
204 VITTORI CT, COLEVILLE, CA 96107-9403
(530) 495-2557
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
06/09/2006
Last updated
07/08/2007
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