Provider Demographics
NPI:1790737526
Name:GILBERT, RANDALL CURTIS (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:CURTIS
Last Name:GILBERT
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 1:1740 S WESTGATE AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3792
Mailing Address - Country:US
Mailing Address - Phone:310-842-7500
Mailing Address - Fax:
Practice Address - Street 1:9808 VENICE BLVD STE 603
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-6819
Practice Address - Country:US
Practice Address - Phone:310-842-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55905207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G559050Medicaid
CABG0164789OtherDEA NUMBER
CA00G559050Medicaid
CA00G559050Medicaid
CA8W878AMedicare PIN