Healthcare Provider Details

I. General information

NPI: 1427140367
Provider Name (Legal Business Name): JERRY RAND APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4241 JUTLAND DR SUITE 202
SAN DIEGO CA
92117-3663
US

IV. Provider business mailing address

4241 JUTLAND DR SUITE 202
SAN DIEGO CA
92117-3663
US

V. Phone/Fax

Practice location:
  • Phone: 858-274-6633
  • Fax: 858-274-6643
Mailing address:
  • Phone: 858-274-6633
  • Fax: 858-274-6643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License NumberBR7775868
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number370055AP
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License NumberG25749
License Number StateCA

VIII. Authorized Official

Name: DR. JERRY NEIL RAND
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 858-274-6633