=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780998542
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R. PAUL ST. AMAND, M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2010
-----------------------------------------------------
Last Update Date | 08/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4560 ADMIRALTY WAY STE. 355
-----------------------------------------------------
City | MARINA DEL REY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90292-5423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-577-7510
-----------------------------------------------------
Fax | 310-821-0664
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4560 ADMIRALTY WAY STE. 355
-----------------------------------------------------
City | MARINA DEL REY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90292-5423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-577-7510
-----------------------------------------------------
Fax | 310-821-0664
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ROGER P. ST. AMAND
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 310-577-7510
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | G2487
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------