=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770612699
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUDOLPH GARCIA ALANIS O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2007
-----------------------------------------------------
Last Update Date | 01/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44139 MONTEREY AVE STE A
-----------------------------------------------------
City | PALM DESERT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92260-8700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-469-5195
-----------------------------------------------------
Fax | 760-779-0801
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10768 NUTMEG CIR
-----------------------------------------------------
City | FONTANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92337-7653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-473-7449
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPT12788TPL
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------