Provider Demographics
NPI:1033483193
Name:JONATHAN D. RAND, M.D. INC
Entity Type:Organization
Organization Name:JONATHAN D. RAND, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:RAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-821-9800
Mailing Address - Street 1:4644 LINCOLN BLVD
Mailing Address - Street 2:113
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6313
Mailing Address - Country:US
Mailing Address - Phone:310-821-9800
Mailing Address - Fax:310-306-0263
Practice Address - Street 1:4644 LINCOLN BLVD
Practice Address - Street 2:113
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6313
Practice Address - Country:US
Practice Address - Phone:310-821-9800
Practice Address - Fax:310-306-0263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37418207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG37418BMedicare PIN
CAA47075Medicare UPIN