Provider Demographics
NPI:1427140367
Name:JERRY RAND APMC
Entity type:Organization
Organization Name:JERRY RAND APMC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:RAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-274-6633
Mailing Address - Street 1:4241 JUTLAND DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-3663
Mailing Address - Country:US
Mailing Address - Phone:858-274-6633
Mailing Address - Fax:858-274-6643
Practice Address - Street 1:4241 JUTLAND DR
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-3663
Practice Address - Country:US
Practice Address - Phone:858-274-6633
Practice Address - Fax:858-274-6643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25749261QI0500X
CABR7775868261QP3300X
CA370055AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG25749OtherSTATE ID
CAA42784Medicare UPIN
CAG25749OtherSTATE ID