Healthcare Provider Details

I. General information

NPI: 1811350176
Provider Name (Legal Business Name): JOHN ANDREW MICHEL RUDDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2016
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 UPPER RAGSDALE DR BLDG A
MONTEREY CA
93940-5736
US

IV. Provider business mailing address

100 WILSON RD STE 100
MONTEREY CA
93940-7885
US

V. Phone/Fax

Practice location:
  • Phone: 831-333-3040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA152370
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: