Provider Demographics
NPI:1861619355
Name:DAY, RICHARD G (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:G
Last Name:DAY
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 1:1560 MESA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-6709
Mailing Address - Country:US
Mailing Address - Phone:805-614-5640
Mailing Address - Fax:805-614-5641
Practice Address - Street 1:1560 MESA RD STE 100
Practice Address - Street 2:
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444-6709
Practice Address - Country:US
Practice Address - Phone:805-614-5640
Practice Address - Fax:805-614-5641
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55683207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB234362OtherMEDICARE ID
OH0838071Medicaid
OH0701281Medicare PIN
OH0701281Medicare PIN