Provider Demographics
NPI:1235201377
Name:RUDERMAN, DAVID S (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:RUDERMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1379 PARK WESTERN DR
Mailing Address - Street 2:# 308
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-2300
Mailing Address - Country:US
Mailing Address - Phone:310-784-7224
Mailing Address - Fax:310-519-8388
Practice Address - Street 1:22330 HAWTHORN BLVD
Practice Address - Street 2:SUITE 212
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:310-534-8110
Practice Address - Fax:310-519-8388
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2017-02-20
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Provider Licenses
StateLicense IDTaxonomies
CAG433262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92403Medicare UPIN