Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | 00A157960 | CA |
NPI | 1073543815 |
---|---|
Provider Name | Dr. Joseph Rudison |
First Address | Los Angeles, CA 90003 |
Second Address | Los Angeles, CA 90003-3631 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A81627 | (02) | CA |