Provider Demographics
NPI:1144584970
Name:BALDONI, RUDOLPH C (MD)
Entity Type:Individual
Prefix:DR
First Name:RUDOLPH
Middle Name:C
Last Name:BALDONI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 LINDA ISLE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7208
Mailing Address - Country:US
Mailing Address - Phone:949-675-7928
Mailing Address - Fax:
Practice Address - Street 1:79 LINDA ISLE
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7208
Practice Address - Country:US
Practice Address - Phone:949-675-7928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAFE28948208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice