Healthcare Provider Details

I. General information

NPI: 1467673327
Provider Name (Legal Business Name): JOSEPH F RUDA JR MD (A MEDICAL CORPORATION )
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31671 INDIAN GUIDE RD
SQUAW VALLEY CA
93675-9676
US

IV. Provider business mailing address

31671 INDIAN GUIDE RD
SQUAW VALLEY CA
93675-9676
US

V. Phone/Fax

Practice location:
  • Phone: 559-332-2015
  • Fax: 559-332-9105
Mailing address:
  • Phone: 559-332-2015
  • Fax: 559-332-9105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA324630
License Number StateCA

VIII. Authorized Official

Name: DR. JOSEPH FRANK RUDA JR.
Title or Position: PRESIDENT
Credential: PYSICIAN MD
Phone: 559-332-2015