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General NPI Number Information
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NPI Number | 1962974857
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Entity Type | Organization
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Legal Business Name | RUDRAH CORP
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Dates
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Enumeration Date | 12/18/2018
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Last Update Date | 12/18/2018
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Provider Practice Location Address
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Address Line | 515 E ORANGEBURG AVE
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City | MODESTO
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State | CA
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Zip | 95350-5510
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Country | US
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Telephone | 209-979-9841
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 577003
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City | MODESTO
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State | CA
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Zip | 95357-7003
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Country | US
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Telephone | 203-979-6841
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PANKAJ MALHOTRA
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Credential | MD
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Telephone | 203-979-6841
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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