Provider Demographics
NPI:1407871106
Name:RAND, JONATHAN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DAVID
Last Name:RAND
Suffix:
Gender:M
Credentials:MD
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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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2011-10-19
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Provider Licenses
StateLicense IDTaxonomies
CAG37418207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG37418BMedicare PIN
A47075Medicare UPIN