MEDICARE: DR. ALEJANDRO RANA CUSTODIO MD, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	A196911	CA

General Provider Information

NPI Number	:	1861079295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEJANDRO RANA CUSTODIO MD, MS

Provider Business Mailing Address
First Line	:	9375 SAN FERNANDO RD
Second Line	:
City	:	SUN VALLEY
State	:	CA
Zip	:	91352-1428
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9375 SAN FERNANDO RD
Second Line	:
City	:	SUN VALLEY
State	:	CA
Zip	:	91352-1428
Country	:	US
Telephone Number	:	818-768-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2021
Last Update Date	:	06/19/2024

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