Healthcare Provider Details

I. General information

NPI: 1760412050
Provider Name (Legal Business Name): RAN REGEV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 MEDICAL CENTER CT
CHULA VISTA CA
91911-6617
US

IV. Provider business mailing address

1848 MENDOTA ST
SAN DIEGO CA
92106
US

V. Phone/Fax

Practice location:
  • Phone: 619-482-5800
  • Fax: 619-482-5800
Mailing address:
  • Phone: 520-891-5005
  • Fax: 619-819-7955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA96685
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: