Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Richard Alfonso Licon, PA-C

Individual provider Physician Assistant · NPI 1740428101

Richard Alfonso Licon, PA-C is a Physician Assistant in Santa Ana, California. Qualified in 1984, 42 years ago. Practices with Nellie Gail Urgent Care Medical Corp, a 4-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
42
Licensed in
CA
In the registry since
2009
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1401 W 1st St Ste 101
Santa Ana, CA 92703-3757
Phone: (714) 542-9700
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA11666 (CA)

Record details

NPI number1740428101
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJanuary 23, 2009
Last updated in NPPESApril 25, 2023
Certification dateApril 25, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 1984 (42 years in practice)
Group practice Nellie Gail Urgent Care Medical Corp — 4 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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