Healthcare Provider Details

I. General information

NPI: 1902885684
Provider Name (Legal Business Name): RUDOLPH A. BEDFORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 20TH ST STE 280
SANTA MONICA CA
90404-2053
US

IV. Provider business mailing address

1301 20TH ST STE 280
SANTA MONICA CA
90404-2053
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-6789
  • Fax: 310-935-3163
Mailing address:
  • Phone: 310-829-6789
  • Fax: 310-935-3163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA52659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: