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General NPI Number Information
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NPI Number | 1487896767
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Entity Type | Individual
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Provider Name | MICHAEL C RANDALL M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/01/2009
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Last Update Date | 04/01/2009
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Provider Practice Location Address
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Address Line | 4924 BALBOA BLVD # 107
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City | ENCINO
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State | CA
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Zip | 91316-3402
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Country | US
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Telephone | 310-601-4404
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Fax |
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Provider Business Mailing Address
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Address Line | 4924 BALBOA BLVD, #107
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City | ENCINO
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State | CA
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Zip | 91316
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Country | US
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Telephone | 310-601-4404
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | G37167
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License Number State | CA
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