MEDICARE: NINA RUDNICK

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	103TC2200X	Clinical Child & Adolescent Psychologist

General Provider Information

NPI Number	:	1952469173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NINA RUDNICK

Provider Business Mailing Address
First Line	:	738 ALCATRAZ AVE
Second Line	:	#1
City	:	OAKLAND
State	:	CA
Zip	:	94609-1040
Country	:	US
Telephone Number	:	510-684-7541
Fax Number	:

Provider Business Practice Location Address
First Line	:	738 ALCATRAZ AVE
Second Line	:	#1
City	:	OAKLAND
State	:	CA
Zip	:	94609-1040
Country	:	US
Telephone Number	:	510-684-7541
Fax Number	:

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	09/15/2009

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Directions to “ NINA RUDNICK ” Practice Location

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