Richard Anthony Jack, M.D.
Pediatrics, Neonatal-Perinatal Medicine in Tarzana, CA. Individual provider (NPI-1).
NPI number1306289129
StatusActive
Last updated in NPPESDec 28, 2022
Details
- NPI
- 1306289129
- Entity type
- Individual (NPI-1)
- Name
- Richard Anthony Jack
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 10, 2013
- Certification date
- Dec 28, 2022
- Last updated
- Dec 28, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2080N0001X | Pediatrics, Neonatal-Perinatal Medicine | C175889 | CA | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
18321 Clark StTarzana, CA 91356-3501
Phone 818-708-5570 · Fax 818-708-5471
Mailing address
4140 W 190th StTorrance, CA 90504-5513
Other practice locations
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