Randall E Coriell, M.D.
Individual provider Active NPI Family Medicine Physician · Highland, CA
NPI 1912931056 · NPPES record last updated Feb 28, 2020
Key facts
- NPI
- 1912931056
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- G45041 (CA)
- Practice address
- 7000 Boulder Ave
Highland, CA 92346-3348 - Phone
- (909) 862-1191
- Fax
- (909) 796-4158
- NPI assigned
- Jul 11, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G45041 | CA | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | G45041 | CA | Yes |
Addresses
Primary practice location
7000 Boulder Ave
Highland, CA 92346-3348
Mailing address
PO Box 10069
San Bernardino, CA 92423-0069
Phone (909) 335-4188
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G450410 | Medicaid | CA |
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- Lloyd Costello
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All providers in Highland, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 28, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.