Healthcare Provider Details

I. General information

NPI: 1811940190
Provider Name (Legal Business Name): LUDVOICO K REDULA JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: VIC K REDULA JR. M.D.

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 BANGS AVE
MODESTO CA
95356-8713
US

IV. Provider business mailing address

625 JOHN KAMPS WAY
RIPON CA
95366-9471
US

V. Phone/Fax

Practice location:
  • Phone: 209-557-1749
  • Fax: 209-557-1685
Mailing address:
  • Phone: 310-384-0909
  • Fax: 209-557-1685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG63193
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: