Organization
RANDALL G. SHUE D.O. INC.
Active
Parent organization
RANDALL G. SHUE D.O. INC.
Other names
LA Procedure Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
RANDALL G. SHUE D.O. INC.
Authorized official
DR. RANDALL G SHUE D.O. (PRESIDENT)
(323) 268-3491
Entity
Organization
Contact information
Practice address
4055 E OLYMPIC BLVD, SUITE 210, LOS ANGELES, CA 90023-3345
(323) 268-3491
Mailing address
4055 E OLYMPIC BLVD, SUITE 210, LOS ANGELES, CA 90023-3345
(323) 268-3491
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
20A5142
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00AX51420
—
CA
Enumeration date
08/17/2012
Last updated
08/17/2012
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