Healthcare Provider Details

I. General information

NPI: 1295736676
Provider Name (Legal Business Name): RUDO BENJAMIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 TORRANCE BLVD. 2ND FLOOR CHE
TORRANCE CA
90503
US

IV. Provider business mailing address

21311 MADRONA AVENUE SUITE 101
TORRANCE CA
90503
US

V. Phone/Fax

Practice location:
  • Phone: 310-303-6833
  • Fax:
Mailing address:
  • Phone: 310-792-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA75136
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA75136
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: