Provider Demographics
NPI:1184838823
Name:GELISH, RUDETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:RUDETTE
Middle Name:
Last Name:GELISH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5193
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90296
Mailing Address - Country:US
Mailing Address - Phone:310-871-5301
Mailing Address - Fax:310-546-4548
Practice Address - Street 1:2100 N SEPULVEDA BLVD STE 26
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2957
Practice Address - Country:US
Practice Address - Phone:310-871-5301
Practice Address - Fax:310-546-4548
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38668106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist