MEDICARE: JOANNA L RUDIN RN-BSN

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	163W00000X	Registered Nurse	701579	CA

General Provider Information

NPI Number	:	1568051241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA L RUDIN RN-BSN

Provider Business Mailing Address
First Line	:	117 S JUANITA AVE # B
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3436
Country	:	US
Telephone Number	:	310-940-2449
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 S JUANITA AVE # B
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3436
Country	:	US
Telephone Number	:	310-940-2449
Fax Number	:

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

Provider Enumeration Date	:	01/15/2021
Last Update Date	:	01/15/2021

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