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General NPI Number Information
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NPI Number | 1740452259
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Entity Type | Organization
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Legal Business Name | HORST R. RUDRICH MEDICAL CORPORATION
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Dates
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Enumeration Date | 03/25/2008
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Last Update Date | 03/12/2015
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Provider Practice Location Address
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Address Line | 255 TERRACINA BLVD STE. 105
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City | REDLANDS
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State | CA
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Zip | 92373-4870
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Country | US
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Telephone | 909-793-0323
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Fax | 909-793-9173
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Provider Business Mailing Address
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Address Line | 1574 EDGEHILL LN
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City | REDLANDS
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State | CA
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Zip | 92373-6523
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Country | US
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Telephone | 909-798-3061
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Fax | 909-798-1221
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Authorized Official
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Title or Position | PHYSICIAN / PRESIDENT
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Name | HORST R RUDRICH
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Credential | D.O.
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Telephone | 909-798-3061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A5970
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License Number State | CA
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