MEDICARE: DR. RUDY Y SANTOS MD

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
1	208M00000X	Hospitalist Physician	C53119	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MD418624	OTHER	PA	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	C53119	OTHER	CA	CA LICENSE

General Provider Information

NPI Number	:	1336149749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUDY Y SANTOS MD

Provider Business Mailing Address
First Line	:	179 YULUPA CIR
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-5154
Country	:	US
Telephone Number	:	707-888-4415
Fax Number	:

Provider Business Practice Location Address
First Line	:	1165 MONTGOMERY DR
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-4801
Country	:	US
Telephone Number	:	707-888-4415
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	06/29/2023

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