Provider Demographics
NPI:1366580466
Name:RICHTER, TODD C (PA-C)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:C
Last Name:RICHTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 491509
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-1509
Mailing Address - Country:US
Mailing Address - Phone:530-768-1064
Mailing Address - Fax:530-215-1609
Practice Address - Street 1:605 W EAST AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-7201
Practice Address - Country:US
Practice Address - Phone:530-343-4757
Practice Address - Fax:530-343-3347
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 15546363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ27575ZOtherGROUP PTAN
CAP2236Medicare UPIN
CA0PA155460Medicare PIN