Healthcare Provider Details

I. General information

NPI: 1558440131
Provider Name (Legal Business Name): RANDY PAUL FIORENTINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W STEWART DR SUITE 305
ORANGE CA
92868-3854
US

IV. Provider business mailing address

1310 W STEWART DR SUITE 305
ORANGE CA
92868-3854
US

V. Phone/Fax

Practice location:
  • Phone: 714-538-7699
  • Fax: 714-997-1098
Mailing address:
  • Phone: 714-538-7699
  • Fax: 714-997-1098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG083405
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: