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General NPI Number Information
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NPI Number | 1033483193
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Entity Type | Organization
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Legal Business Name | JONATHAN D. RAND, M.D. INC
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Dates
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Enumeration Date | 03/06/2012
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Last Update Date | 03/06/2012
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Provider Practice Location Address
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Address Line | 4644 LINCOLN BLVD 113
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6313
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Country | US
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Telephone | 310-821-9800
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Fax | 310-306-0263
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Provider Business Mailing Address
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Address Line | 4644 LINCOLN BLVD 113
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6313
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Country | US
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Telephone | 310-821-9800
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Fax | 310-306-0263
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. JONATHAN D RAND
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Credential | M.D.
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Telephone | 310-821-9800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G37418
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License Number State | CA
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