Provider Demographics
NPI:1962631101
Name:RANEY, AIDAN RUPERT (MD)
Entity Type:Individual
Prefix:
First Name:AIDAN
Middle Name:RUPERT
Last Name:RANEY
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 1:1140 W LA VETA AVE
Mailing Address - Street 2:STE 430
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4225
Mailing Address - Country:US
Mailing Address - Phone:714-543-5555
Mailing Address - Fax:714-836-2427
Practice Address - Street 1:1140 W LA VETA AVE
Practice Address - Street 2:STE 430
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4225
Practice Address - Country:US
Practice Address - Phone:714-543-5555
Practice Address - Fax:714-836-2427
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106672207RC0000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB237614Medicare PIN