Provider Demographics
NPI:1912962614
Name:RANDALL, JOSH MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSH
Middle Name:MATTHEW
Last Name:RANDALL
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 1:23961 CALLE DE LA MAGDALENA STE 500
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-7622
Mailing Address - Country:US
Mailing Address - Phone:949-855-1101
Mailing Address - Fax:498-558-7109
Practice Address - Street 1:23961 CALLE DE LA MAGDALENA STE 500
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7622
Practice Address - Country:US
Practice Address - Phone:498-551-1019
Practice Address - Fax:498-558-7109
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85620208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI18032Medicare UPIN
CAWA85620AMedicare PIN