Provider Demographics
NPI:1033640313
Name:RUDRA, RENUKA TANIA (MD)
Entity Type:Individual
Prefix:MISS
First Name:RENUKA
Middle Name:TANIA
Last Name:RUDRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 888584
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90088-8584
Mailing Address - Country:US
Mailing Address - Phone:925-691-9806
Mailing Address - Fax:925-691-9807
Practice Address - Street 1:1701 SOLAR DR STE 140
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-0136
Practice Address - Country:US
Practice Address - Phone:805-366-4667
Practice Address - Fax:805-336-4647
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA175678208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation