Provider Demographics
NPI:1134287352
Name:HUDLER, ELIZABETH RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:RUTH
Last Name:HUDLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 CAMINO DEL MAR STE F
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2645
Mailing Address - Country:US
Mailing Address - Phone:858-208-3280
Mailing Address - Fax:858-605-4595
Practice Address - Street 1:1125 CAMINO DEL MAR STE F
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2645
Practice Address - Country:US
Practice Address - Phone:858-208-3280
Practice Address - Fax:858-605-4595
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA787212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A787210Medicaid
CAW416Medicare PIN
CAI03923Medicare UPIN
CA00A787210Medicaid