Provider Demographics
NPI:1528130671
Name:RAU, JAMES EDWARD (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:RAU
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:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-0081
Mailing Address - Country:US
Mailing Address - Phone:562-420-9202
Mailing Address - Fax:866-341-1049
Practice Address - Street 1:650 SAN LORENZO ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90402-1322
Practice Address - Country:US
Practice Address - Phone:562-420-9202
Practice Address - Fax:866-341-1049
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24244207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A242440Medicaid
CAA24244Medicare ID - Type Unspecified
CA00A242440Medicaid