Provider Demographics
NPI:1053475822
Name:CALDRON, RANDALL A (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:A
Last Name:CALDRON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7230 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1907
Mailing Address - Country:US
Mailing Address - Phone:818-518-5980
Mailing Address - Fax:818-337-2049
Practice Address - Street 1:7230 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 302
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1907
Practice Address - Country:US
Practice Address - Phone:818-518-5980
Practice Address - Fax:818-337-2049
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64420207P00000X, 207R00000X
CAA66420207RB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW753Medicare ID - Type UnspecifiedCA MEDICARE
H03742Medicare UPIN