Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 20A10511 | CA |
N | 207QS0010X | Family Doctor - Sports Medicine | 20A10511 | CA |
N | 2081S0010X | Sports Medicine | 20A10511 | CA |
N | 213ES0000X | Sports Medicine | 20A10511 | CA |
Y | 208D00000X | General Practice Physician | 20A10511 | CA |
NPI | 1487804308 |
---|---|
Provider Name | Rand Mcclain |
First Address | Santa Monica, CA 90403-5652 |
Second Address | Santa Monica, CA 90403-5652 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2008 |
Last Update Date | 28/09/2008 |