Provider Demographics
NPI:1639103260
Name:RUDOLF, JAMES D (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:RUDOLF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25455 BARTON RD.
Mailing Address - Street 2:SUITE 212A
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3177
Mailing Address - Country:US
Mailing Address - Phone:909-799-8182
Mailing Address - Fax:909-799-9649
Practice Address - Street 1:25455 BARTON RD.
Practice Address - Street 2:SUITE 212A
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3177
Practice Address - Country:US
Practice Address - Phone:909-799-8182
Practice Address - Fax:909-799-9649
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50751207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G507511Medicaid
CA00G507510Medicare ID - Type Unspecified
CAD42774Medicare UPIN