Healthcare Provider Details

I. General information

NPI: 1215179163
Provider Name (Legal Business Name): ANDREW GENE RUDIKOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLZ DEPT OF ANESTHESIOLOGY UCLA MEDICAL CENTER
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

757 WESTWOOD PLZ SUITE 3304 DEPT OF ANESTHESIOLOGY UCLA MEDICAL CENTER
LOS ANGELES CA
90095-7403
US

V. Phone/Fax

Practice location:
  • Phone: 310-267-8655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberA105724
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: