Healthcare Provider Details

I. General information

NPI: 1750476891
Provider Name (Legal Business Name): ROBERT NUDELMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 LA VENTA DRIVE 103
WESTLAKE VILLAGE CA
91361
US

IV. Provider business mailing address

1250 LA VENTA DRIVE 103
WESTLAKE VILLAGE CA
91361
US

V. Phone/Fax

Practice location:
  • Phone: 805-495-0841
  • Fax: 805-497-6912
Mailing address:
  • Phone: 805-495-0841
  • Fax: 805-497-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG41996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: