Provider Demographics
NPI:1417283821
Name:DRUDA, RANI
Entity Type:Individual
Prefix:
First Name:RANI
Middle Name:
Last Name:DRUDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 CENTER BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1764
Mailing Address - Country:US
Mailing Address - Phone:415-717-9069
Mailing Address - Fax:
Practice Address - Street 1:751 CENTER BLVD
Practice Address - Street 2:STE A
Practice Address - City:FAIRFAX
Practice Address - State:CA
Practice Address - Zip Code:94930-1764
Practice Address - Country:US
Practice Address - Phone:415-717-9069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27599111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor