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General NPI Number Information
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NPI Number | 1215562236
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Entity Type | Organization
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Legal Business Name | WALK RUN RANDALL
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Dates
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Enumeration Date | 03/10/2020
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Last Update Date | 03/10/2020
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Provider Practice Location Address
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Address Line | 28829 PUJOL ST APT 718
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City | TEMECULA
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State | CA
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Zip | 92590-6710
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Country | US
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Telephone | 267-934-6996
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Fax |
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Provider Business Mailing Address
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Address Line | 28829 PUJOL ST APT 718
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City | TEMECULA
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State | CA
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Zip | 92590-6710
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Country | US
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Telephone | 267-934-6996
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARTINA RENE RANDALL
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Credential | DPM,AACFAS
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Telephone | 267-934-6996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number |
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License Number State |
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