Healthcare Provider Details

I. General information

NPI: 1942761861
Provider Name (Legal Business Name): RUDOLF ESTESS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 VETERANS BLVD
REDWOOD CITY CA
94063-2037
US

IV. Provider business mailing address

15019 N 100TH WAY
SCOTTSDALE AZ
85260-9231
US

V. Phone/Fax

Practice location:
  • Phone: 650-299-2015
  • Fax:
Mailing address:
  • Phone: 650-531-6851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A19475
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: