Healthcare Provider Details

I. General information

NPI: 1639992068
Provider Name (Legal Business Name): NATHAN RUDOMETKIN MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24361 EL TORO RD STE 160
LAGUNA WOODS CA
92637-8897
US

IV. Provider business mailing address

24361 EL TORO RD STE 160
LAGUNA WOODS CA
92637-8897
US

V. Phone/Fax

Practice location:
  • Phone: 951-283-8784
  • Fax:
Mailing address:
  • Phone: 951-283-8784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: NATHAN RUDOMETKIN
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 951-283-8784