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General NPI Number Information
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NPI Number | 1669897674
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Entity Type | Individual
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Provider Name | MRS. ELGEDINE RUDOLPH
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Gender | Female
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Dates
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Enumeration Date | 02/27/2014
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 631 MAPLE AVE # B
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City | LOS ANGELES
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State | CA
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Zip | 90014-2211
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Country | US
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Telephone | 213-673-3001
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Fax | 213-626-2458
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Provider Business Mailing Address
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Address Line | 12021 WILMINGTON AVE STE D
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City | LOS ANGELES
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State | CA
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Zip | 90059-3019
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Country | US
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Telephone | 323-528-9845
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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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 | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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