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General NPI Number Information
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NPI Number | 1427499904
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Entity Type | Individual
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Provider Name | JAN RUDALGO ADAMS M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/11/2013
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Last Update Date | 07/11/2013
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Provider Practice Location Address
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Address Line | 17150 EUCLID ST
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-4092
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Country | US
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Telephone | 714-918-5184
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Fax | 714-918-5172
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Provider Business Mailing Address
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Address Line | 6261 VIEW CREST DR
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City | OAKLAND
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State | CA
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Zip | 94619-3719
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Country | US
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Telephone | 510-530-4688
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Fax | 510-530-4689
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 51004
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License Number State | CA
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