Provider Demographics
NPI:1194000216
Name:RUDD-BARNARD, ALEXANDRA HAZEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:HAZEL
Last Name:RUDD-BARNARD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11633 SAN VICENTE BLVD
Mailing Address - Street 2:106
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6511
Mailing Address - Country:US
Mailing Address - Phone:310-207-1720
Mailing Address - Fax:310-207-1638
Practice Address - Street 1:11633 SAN VICENTE BLVD
Practice Address - Street 2:106
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6511
Practice Address - Country:US
Practice Address - Phone:310-207-1720
Practice Address - Fax:310-207-1638
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019294103G00000X
CAPSY25369103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical