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General NPI Number Information
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NPI Number | 1225128994
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Entity Type | Individual
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Provider Name | NATHAN JEROME RUDOMETKIN MD
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 24361 EL TORO RD STE 160
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City | LAGUNA WOODS
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State | CA
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Zip | 92637-8897
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Country | US
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Telephone | 949-534-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 24361 EL TORO RD STE 160
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City | LAGUNA WOODS
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State | CA
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Zip | 92637-8897
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Country | US
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Telephone | 949-534-4000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD60929372
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | A81443
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | A81443
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License Number State | CA
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