Healthcare Provider Details

I. General information

NPI: 1356259634
Provider Name (Legal Business Name): RUDOLPH LABETA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 VALLEY VIEW AVE
NORCO CA
92860-2959
US

IV. Provider business mailing address

1503 VALLEY VIEW AVE
NORCO CA
92860-2959
US

V. Phone/Fax

Practice location:
  • Phone: 760-519-6137
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberXKDK3L
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: