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NPI Code Detail

MEDICARE: JAMIE RUDDEN

MEDICARE: JAMIE RUDDEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist145124CA

General Provider Information

NPI Number : 1013784628
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE RUDDEN
Provider Business Mailing Address
First Line : 121 BROOKS AVE
Second Line :
City : VENICE
State : CA
Zip : 90291-3254
Country : US
Telephone Number : 954-633-7294
Fax Number :
Provider Business Practice Location Address
First Line : 12424 WILSHIRE BLVD STE 650
Second Line :
City : LOS ANGELES
State : CA
Zip : 90025-1081
Country : US
Telephone Number : 954-633-7294
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2023
Last Update Date : 03/20/2024

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Directions to “ JAMIE RUDDEN ” Practice Location

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