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General NPI Number Information
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NPI Number | 1316085293
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Entity Type | Individual
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Provider Name | STEVEN E RUDOLPH DO
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Gender | Male
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 11230 SORRENTO VALLEY RD STE 135
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City | SAN DIEGO
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State | CA
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Zip | 92121
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Country | US
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Telephone | 858-450-6650
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Fax | 858-450-6651
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Provider Business Mailing Address
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Address Line | 11230 SORRENTO VALLEY RD STE 135
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City | SAN DIEGO
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State | CA
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Zip | 92121
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Country | US
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Telephone | 858-450-6650
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Fax | 858-450-6651
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 20A6389
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | 20A6389
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 2046389
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License Number State | CA
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