Healthcare Provider Details

I. General information

NPI: 1487841482
Provider Name (Legal Business Name): RAJANI RUDRANGI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W HOSPITAL RD
FRENCH CAMP CA
95231-9693
US

IV. Provider business mailing address

P.O. BOX 1020
STOCKTON CA
95201-1020
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-6820
  • Fax: 209-468-6103
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberBP1-0048489
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA109478
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: