Provider Demographics
NPI:1043273428
Name:RUDD, DALE A (ATC)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:A
Last Name:RUDD
Suffix:
Gender:M
Credentials:ATC
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Mailing Address - Street 1:24124 VISTA HILLS DR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-2835
Mailing Address - Country:US
Mailing Address - Phone:310-794-1547
Mailing Address - Fax:310-206-1985
Practice Address - Street 1:325 WESTWOOD PLZ
Practice Address - Street 2:ACOSTA ATHLETIC TRAINING CENTER
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-8356
Practice Address - Country:US
Practice Address - Phone:310-794-1547
Practice Address - Fax:319-206-1985
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer