Individual
SAMUEL R RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
200 MERCY CIR, OCEANSIDE, CA 92055
(760) 725-1288
Mailing address
637 LUTHER DR, IRON STATION, NC 28080-6780
(636) 219-3575
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
04235919SR
NC
Other
Enumeration date
01/26/2024
Last updated
01/26/2024
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