Healthcare Provider Details

I. General information

NPI: 1083650782
Provider Name (Legal Business Name): NEIL D RUDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 09/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 SAN JOSE ST
SALINAS CA
93901-3901
US

IV. Provider business mailing address

PO BOX 4363
SALINAS CA
93912-4363
US

V. Phone/Fax

Practice location:
  • Phone: 831-424-7839
  • Fax:
Mailing address:
  • Phone: 831-649-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG32385
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: