Fortuna, Randall S
Fortuna, Randall S is an individual health care provider with primary practice located at 11234 Anderson St # 7100 , Loma Linda CA 92354-2804. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Vascular Surgery, Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery). Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) is his primary health care specialty. Fortuna, Randall S can be contacted via phone (909) 558-4200.Contact Information
Primary practice address
11234 Anderson St # 7100
Loma Linda CA 92354-2804
Phone: (909) 558-4200
Fax: (909) 558-2401
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Vascular Surgery | 2086S0129X | 036109764 | Illinois |
| Allopathic & Osteopathic Physicians / Vascular Surgery | 2086S0129X | 036-109764 | Illinois |
| Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | 036109764 | Illinois |
| Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | 49534 | Arizona |
| Allopathic & Osteopathic Physicians / Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | A68643 | California |
Profile Details
| NPI number | 1285607986 |
|---|---|
| LBN Legal business name | Fortuna, Randall S |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 12th, 2006 |
| Last updated | Oct 31st, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1285607986 | NPPES |
| Illinois | Other | 07215075 | BLUE SHIELD PROVIDER NUMB |
| Illinois | MEDICAID | 036109764 | BLUE SHIELD PROVIDER NUMB |
| Illinois | Other | IL0138 | BLUE SHIELD PROVIDER NUMB |
| Illinois | MEDICAID | 934932 | BLUE SHIELD PROVIDER NUMB |
| Illinois | Other | P00038024/CA5138 | BLUE SHIELD PROVIDER NUMB |
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