Active NPI
Keith Randle
- Clinical Medical Laboratory
- Newport Beach, CA
National Provider Identifier
1285001438
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Medical Laboratory
- License
- CLR00348278
- Practice address
- 2100 Highland Dr
Newport Beach, CA 92660-4408 - Phone
- (949) 689-8880
- NPI assigned
- Aug 24, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | CLR00348278 | CA | Primary |
Addresses
Primary practice location
2100 Highland Dr
Newport Beach, CA 92660-4408
Mailing address
2100 Highand Drive
Newport Beach, CA 92660-4408
Phone (949) 689-8880
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CLR00348278 | CA | MD | Clinical Medical Laboratory |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1440374400000",
"number": "1285001438",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2100 HIGHAND DRIVE",
"city": "NEWPORT BEACH",
"state": "CA",
"postal_code": "926604408",
"telephone_number": "949-689-8880"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 HIGHLAND DR",
"city": "NEWPORT BEACH",
"state": "CA",
"postal_code": "926604408",
"telephone_number": "949-689-8880"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDLE",
"first_name": "KEITH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-08-24",
"last_updated": "2015-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": "CA",
"license": "CLR00348278",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newport Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.