Provider Demographics
NPI:1265553531
Name:RANDAL HAWORTH M.D. F.A.C.S.
Entity type:Organization
Organization Name:RANDAL HAWORTH M.D. F.A.C.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWORTH M.D.
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACS
Authorized Official - Phone:310-273-3000
Mailing Address - Street 1:436 N BEDFORD DRIVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210
Mailing Address - Country:US
Mailing Address - Phone:310-273-3000
Mailing Address - Fax:310-273-8802
Practice Address - Street 1:436 N BEDFORD DRIVE
Practice Address - Street 2:SUITE 105
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-9021
Practice Address - Country:US
Practice Address - Phone:310-273-3000
Practice Address - Fax:310-279-8802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Multi-Specialty