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General NPI Number Information
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NPI Number | 1639992068
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Entity Type | Organization
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Legal Business Name | NATHAN RUDOMETKIN MD, INC
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Dates
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Enumeration Date | 11/04/2024
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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 | 951-283-8784
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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 | 951-283-8784
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | NATHAN RUDOMETKIN
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Credential | MD
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Telephone | 951-283-8784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number |
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License Number State |
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