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General NPI Number Information
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NPI Number | 1780268631
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Entity Type | Organization
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Legal Business Name | RANDALL FOOT AND ANKLE SURGERY INC
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Dates
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Enumeration Date | 05/07/2021
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 2800 PACIFIC AVE STE D
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City | LONG BEACH
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State | CA
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Zip | 90806-1468
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Country | US
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Telephone | 562-337-8401
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Fax |
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Provider Business Mailing Address
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Address Line | 6444 SAN FERNANDO RD UNIT 5611
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City | GLENDALE
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State | CA
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Zip | 91201-2124
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Country | US
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Telephone | 323-672-6549
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARTINA RANDALL
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Credential |
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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