Healthcare Provider Details

I. General information

NPI: 1285079509
Provider Name (Legal Business Name): RANDA ABDULLAH GORGES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RANDA ABDULLAH KARIM

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W CHASE AVE
EL CAJON CA
92020-5710
US

IV. Provider business mailing address

823 GATEWAY CENTER WAY
SAN DIEGO CA
92102-4541
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-2499
  • Fax:
Mailing address:
  • Phone: 619-515-2300
  • Fax: 619-906-4564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA138815
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: