Provider Demographics
NPI:1174375943
Name:RADA, RICHARD MICHAEL
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:MICHAEL
Last Name:RADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N VAL VISTA DR LOT 51
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-8627
Mailing Address - Country:US
Mailing Address - Phone:480-205-4609
Mailing Address - Fax:
Practice Address - Street 1:120 N VAL VISTA DR LOT 51
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-8627
Practice Address - Country:US
Practice Address - Phone:480-205-4609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker