Provider Demographics
NPI:1558440131
Name:FIORENTINO, RANDY PAUL (MD)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:PAUL
Last Name:FIORENTINO
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 1:1310 W STEWART DR
Mailing Address - Street 2:SUITE 305
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3854
Mailing Address - Country:US
Mailing Address - Phone:714-538-7699
Mailing Address - Fax:714-997-1098
Practice Address - Street 1:1310 W STEWART DR
Practice Address - Street 2:SUITE 305
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3854
Practice Address - Country:US
Practice Address - Phone:714-538-7699
Practice Address - Fax:714-997-1098
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG083405207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G-834050OtherMEDICAL PROVIDER NUMBER
CAG23053Medicare UPIN