Provider Demographics
NPI:1295221125
Name:RUDOLPH, ALEXANDRIA (AGACNP)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:RUDOLPH
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8585 BURTON WAY APT 112
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-3364
Mailing Address - Country:US
Mailing Address - Phone:310-691-0816
Mailing Address - Fax:
Practice Address - Street 1:14724 VENTURA BLVD STE 420
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3501
Practice Address - Country:US
Practice Address - Phone:888-618-5288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009356363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care