Healthcare Provider Details

I. General information

NPI: 1750432290
Provider Name (Legal Business Name): ELINA RUDOY MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 EXECUTIVE PARK BLVD SUITE 4000
SAN FRANCISCO CA
94134-3303
US

IV. Provider business mailing address

150 EXECUTIVE PARK BLVD SUITE 4000
SAN FRANCISCO CA
94134-3303
US

V. Phone/Fax

Practice location:
  • Phone: 415-871-8805
  • Fax:
Mailing address:
  • Phone: 415-871-8805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number112870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: