=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528130671
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES EDWARD RAU M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2006
-----------------------------------------------------
Last Update Date | 11/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 650 SAN LORENZO ST
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90402-1322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-420-9202
-----------------------------------------------------
Fax | 866-341-1049
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 81
-----------------------------------------------------
City | LOS ALAMITOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90720-0081
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-420-9202
-----------------------------------------------------
Fax | 866-341-1049
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0200X
-----------------------------------------------------
Taxonomy Name | Infectious Disease Physician
-----------------------------------------------------
License Number | A24244
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------