Healthcare Provider Details

I. General information

NPI: 1144952128
Provider Name (Legal Business Name): RIVER S RUDOLPH ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL RUDOLPH

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8945 GOLF LINKS RD
OAKLAND CA
94605-4124
US

IV. Provider business mailing address

8945 GOLF LINKS RD
OAKLAND CA
94605-4124
US

V. Phone/Fax

Practice location:
  • Phone: 628-282-1342
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: