Provider Demographics
NPI:1164637856
Name:ARGUELLO-RUDIN, OSCAR G (MD)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:G
Last Name:ARGUELLO-RUDIN
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 1:715 N WEBER ST STE 200
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1091
Mailing Address - Country:US
Mailing Address - Phone:719-575-9444
Mailing Address - Fax:719-575-9888
Practice Address - Street 1:715 N WEBER ST STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1091
Practice Address - Country:US
Practice Address - Phone:719-575-9444
Practice Address - Fax:719-575-9888
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21892174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01218924Medicaid
CO01218924Medicaid
COAAA2716Medicare PIN