Provider Demographics
NPI:1477740140
Name:MULLINS, RANDALL LEE
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:LEE
Last Name:MULLINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 S VERMONT AVE
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-1349
Mailing Address - Country:US
Mailing Address - Phone:213-480-3460
Mailing Address - Fax:213-252-8878
Practice Address - Street 1:695 S VERMONT AVE
Practice Address - Street 2:8TH FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-1349
Practice Address - Country:US
Practice Address - Phone:213-480-3460
Practice Address - Fax:213-252-8878
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator