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General NPI Number Information
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NPI Number | 1730512203
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Entity Type | Individual
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Provider Name | STEVEN I. RUDOY M.A.
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Gender | Male
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Dates
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Enumeration Date | 08/19/2013
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Last Update Date | 04/03/2017
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Provider Practice Location Address
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Address Line | 1540 E COLORADO ST
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City | GLENDALE
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State | CA
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Zip | 91205-1514
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Country | US
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Telephone | 818-244-7257
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Fax | 818-243-5431
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Provider Business Mailing Address
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Address Line | 437 N HOOVER ST
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City | LOS ANGELES
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State | CA
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Zip | 90004-2306
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Country | US
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Telephone | 310-390-6612
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Fax | 310-398-5690
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 27989
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License Number State | CA
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