Provider Demographics
NPI:1881203313
Name:GINES, RANDY MICHAEL (ARMDS)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:MICHAEL
Last Name:GINES
Suffix:
Gender:M
Credentials:ARMDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:398 CYPRESS AVE UNIT 321
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-3775
Mailing Address - Country:US
Mailing Address - Phone:213-281-1889
Mailing Address - Fax:
Practice Address - Street 1:398 CYPRESS AVE UNIT 321
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-3775
Practice Address - Country:US
Practice Address - Phone:213-281-1889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1449332471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography