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General NPI Number Information
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NPI Number | 1639210149
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Entity Type | Organization
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Legal Business Name | ADELAIDE L RANDAK MD INC
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 10/15/2010
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Provider Practice Location Address
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Address Line | 6325 TOPANGA CANYON BLVD SUITE 412
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City | WOODLAND HILLS
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State | CA
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Zip | 91367-2006
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Country | US
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Telephone | 818-884-7050
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Fax | 818-884-2368
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Provider Business Mailing Address
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Address Line | 6325 TOPANGA CANYON BLVD SUITE 412
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City | WOODLAND HILLS
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State | CA
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Zip | 91367-2006
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Country | US
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Telephone | 818-884-7050
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Fax | 818-884-2368
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ADELAIDE LERI RANDAK
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Credential | MD
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Telephone | 818-884-7050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | G41364
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License Number State | CA
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