Provider Demographics
NPI:1861580631
Name:ONTELL, RICHARD L (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:ONTELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 E CHAPEL
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454
Mailing Address - Country:US
Mailing Address - Phone:805-925-1822
Mailing Address - Fax:805-925-0667
Practice Address - Street 1:821 E CHAPEL
Practice Address - Street 2:SUITE 103
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454
Practice Address - Country:US
Practice Address - Phone:805-925-1822
Practice Address - Fax:805-925-0667
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC32403208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C32403Medicaid
CA00C32403Medicaid
CAA07579773OtherDEA NUMBER
CA00C32403Medicaid
CAC32403Medicare ID - Type Unspecified