Active NPI
Richard Radliff
- Marriage & Family Therapist
- San Andreas, CA
National Provider Identifier
1053893859
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 91358
- Practice address
- 891 Mountain Ranch Rd
San Andreas, CA 95249-9713 - Phone
- (208) 754-6525
- NPI assigned
- Aug 29, 2018
- Last updated
- Jun 3, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 91358 | CA | Primary |
Addresses
Primary practice location
891 Mountain Ranch Rd
San Andreas, CA 95249-9713
Mailing address
PO Box 1508
San Andreas, CA 95249-1508
Phone (408) 665-5662
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 91358 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1535500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654214400000",
"number": "1053893859",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1508",
"city": "SAN ANDREAS",
"state": "CA",
"postal_code": "952491508",
"telephone_number": "408-665-5662"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "891 MOUNTAIN RANCH RD",
"city": "SAN ANDREAS",
"state": "CA",
"postal_code": "952499713",
"telephone_number": "208-754-6525"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RADLIFF",
"first_name": "RICHARD",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-08-29",
"last_updated": "2022-06-03",
"certification_date": "2022-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "91358",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Andreas, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.