Provider Demographics
NPI:1376693226
Name:RUDIN, LAWRENCE S (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:S
Last Name:RUDIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 WESTWOOD BLVD STE 229
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-2942
Mailing Address - Country:US
Mailing Address - Phone:310-478-4331
Mailing Address - Fax:310-587-3484
Practice Address - Street 1:921 WESTWOOD BLVD STE 229
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-2942
Practice Address - Country:US
Practice Address - Phone:310-478-4331
Practice Address - Fax:310-587-3484
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13283103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP13283Medicare ID - Type UnspecifiedMEDICARE NUMBER
CAR25370Medicare UPIN