Provider Demographics
NPI:1023168440
Name:SAFARIK, RANDALL H (MD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:H
Last Name:SAFARIK
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 2208
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93448-2208
Mailing Address - Country:US
Mailing Address - Phone:805-431-1450
Mailing Address - Fax:805-474-4760
Practice Address - Street 1:921 OAK PARK BLVD STE 203
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-3400
Practice Address - Country:US
Practice Address - Phone:805-473-7950
Practice Address - Fax:805-473-7954
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77059207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G770590OtherMEDI-CAL
CA00G770590OtherMEDI-CAL
CAG59736Medicare UPIN