Healthcare Provider Details

I. General information

NPI: 1619956489
Provider Name (Legal Business Name): RICHARD L RUPP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 E CHEVY CHASE DR STE 330
GLENDALE CA
91206
US

IV. Provider business mailing address

1560 E CHEVY CHASE DR SUITE 330
GLENDALE CA
91206-4197
US

V. Phone/Fax

Practice location:
  • Phone: 818-247-0523
  • Fax: 818-247-2945
Mailing address:
  • Phone: 818-247-0523
  • Fax: 818-247-2945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE2014
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: