MEDICARE: JERRY RAND APMC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP3300X	Pain Clinic/Center	BR7775868	CA
2	324500000X	Substance Abuse Rehabilitation Facility	370055AP	CA
3	261QI0500X	Infusion Therapy Clinic/Center	G25749	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G25749	OTHER	CA	STATE ID

General Provider Information

NPI Number	:	1427140367
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JERRY RAND APMC

Provider Business Mailing Address
First Line	:	4241 JUTLAND DR
Second Line	:	SUITE 202
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-3663
Country	:	US
Telephone Number	:	858-274-6633
Fax Number	:	858-274-6643

Provider Business Practice Location Address
First Line	:	4241 JUTLAND DR
Second Line	:	SUITE 202
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-3663
Country	:	US
Telephone Number	:	858-274-6633
Fax Number	:	858-274-6643

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JERRY NEIL RAND
Credential	:	M.D.
Telephone Number	:	858-274-6633

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	11/29/2007

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Directions to “JERRY RAND APMC ” Practice Location

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