Provider Demographics
NPI:1619076155
Name:ST. AMAND, R. PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:R.
Middle Name:PAUL
Last Name:ST. AMAND
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 1:4560 ADMIRALTY WAY
Mailing Address - Street 2:STE. 355
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5423
Mailing Address - Country:US
Mailing Address - Phone:310-577-7510
Mailing Address - Fax:310-821-0664
Practice Address - Street 1:4560 ADMIRALTY WAY
Practice Address - Street 2:STE. 355
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5423
Practice Address - Country:US
Practice Address - Phone:310-577-7510
Practice Address - Fax:310-821-0664
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG2487207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G24870OtherBLUECROSS BLUE SHIELD
CAG02487Medicare ID - Type Unspecified
CA000G24870OtherBLUECROSS BLUE SHIELD