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General NPI Number Information
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NPI Number | 1679683742
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Entity Type | Individual
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Provider Name | AGUSTINUS RUSHANAEDY MD
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 05/31/2016
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Provider Practice Location Address
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Address Line | 6001 TRUXTUN AVE SUITE 220
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City | BAKERSFIELD
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State | CA
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Zip | 93309-0679
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Country | US
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Telephone | 661-323-6660
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 31309
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City | LOS ANGELES
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State | CA
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Zip | 90031-0309
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Country | US
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Telephone | 323-865-3700
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | OR MD 14298
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | MD 00033485
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | A41710
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | MD 10824
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License Number State | HI
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