Healthcare Provider Details

I. General information

NPI: 1972614972
Provider Name (Legal Business Name): RICHARD NEIL RUDD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 REGENT ST SUITE 301
BERKELEY CA
94705-2190
US

IV. Provider business mailing address

10470 OLD PLACERVILLE RD
SACRAMENTO CA
95827-2528
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-8160
  • Fax: 510-841-5535
Mailing address:
  • Phone: 916-854-6666
  • Fax: 916-854-6864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG42981
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: