MEDICARE: RANDY MARION CAINE RN, NP

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	363LA2200X	Adult Health Nurse Practitioner	243615	CA

General Provider Information

NPI Number	:	1750370359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDY MARION CAINE RN, NP

Provider Business Mailing Address
First Line	:	1 ISLANDVIEW
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92604-3601
Country	:	US
Telephone Number	:	949-679-4080
Fax Number	:

Provider Business Practice Location Address
First Line	:	5151 STATE UNIVERSITY DR
Second Line	:	CALIFORNIA STATE UNIVERSITY LOS ANGELES
City	:	LOS ANGELES
State	:	CA
Zip	:	90032-4226
Country	:	US
Telephone Number	:	323-343-4738
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	07/08/2007

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