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General NPI Number Information
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NPI Number | 1235536459
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Entity Type | Individual
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Provider Name | BRITTANY RUDOLPH
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Gender | Female
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Dates
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Enumeration Date | 12/03/2014
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Last Update Date | 02/25/2020
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Provider Practice Location Address
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Address Line | 250 BON AIR RD UNIT B
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City | GREENBRAE
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State | CA
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Zip | 94904-1702
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Country | US
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Telephone | 415-473-6797
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 S EL CAMINO REAL SUITE #200
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City | SAN MATEO
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State | CA
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Zip | 94403-2380
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Country | US
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Telephone | 650-393-8904
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State | CA
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