Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 000000A69403 | CA |
NPI | 1003996257 |
---|---|
Provider Name | Scott Rudkin |
First Address | Los Angeles, CA 90051-3266 |
Second Address | Orange, CA 92868 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 14/12/2007 |