Healthcare Provider Details

I. General information

NPI: 1306362546
Provider Name (Legal Business Name): AMELIA RUDBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SAN LEANDRO BLVD STE 300
SAN LEANDRO CA
94577-1675
US

IV. Provider business mailing address

1000 SAN LEANDRO BLVD STE 300
SAN LEANDRO CA
94577-1675
US

V. Phone/Fax

Practice location:
  • Phone: 651-324-3703
  • Fax:
Mailing address:
  • Phone: 651-324-3703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: