Individual
DR. AMELIA RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3883 AIRWAY DR STE 120, SANTA ROSA, CA 95403-1678
(707) 521-4495
(707) 573-5421
Mailing address
1001 GALAXY WAY STE 400, CONCORD, CA 94520-5725
(925) 225-5837
(925) 225-5838
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
A77253
CA
207Q00000X
Family Medicine Physician
A77253
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
331190099
—
ME
01
—
A77253
STATE MEDICAL LICENSE
CA
Enumeration date
07/26/2006
Last updated
11/03/2022
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