Provider Demographics
NPI:1801837661
Name:TEMPLE DOCTORS GROUP, INC.
Entity Type:Organization
Organization Name:TEMPLE DOCTORS GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:213-382-4211
Mailing Address - Street 1:2080 OUTRIGGER DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-3755
Mailing Address - Country:US
Mailing Address - Phone:916-941-7744
Mailing Address - Fax:213-382-4268
Practice Address - Street 1:240 N VIRGIL AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-5399
Practice Address - Country:US
Practice Address - Phone:213-382-4211
Practice Address - Fax:213-382-4268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Not Answered2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonaryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE25102Medicare UPIN