Provider Demographics
NPI:1376872630
Name:SMITH, RANDY JAMES SR
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:JAMES
Last Name:SMITH
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2549 E VALLEY PKWY
Mailing Address - Street 2:APT 1
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-2972
Mailing Address - Country:US
Mailing Address - Phone:760-432-9880
Mailing Address - Fax:
Practice Address - Street 1:2549 E VALLEY PKWY
Practice Address - Street 2:APT 1
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-2972
Practice Address - Country:US
Practice Address - Phone:760-432-9880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory