Provider Demographics
NPI:1649393059
Name:RUDIN, ERIN BETH (PA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:BETH
Last Name:RUDIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 S WESTLAKE BLVD
Mailing Address - Street 2:SUITE 14, PMB #171
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3108
Mailing Address - Country:US
Mailing Address - Phone:805-285-2225
Mailing Address - Fax:805-285-3291
Practice Address - Street 1:696 HAMPSHIRE RD
Practice Address - Street 2:SUITE 180
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2699
Practice Address - Country:US
Practice Address - Phone:805-285-2225
Practice Address - Fax:805-285-3291
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13957363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPA13957CMedicare PIN
CAWPA13957BMedicare PIN
CAWPA13957DMedicare PIN
CAWPA13957EMedicare PIN
CAW268Medicare PIN
CA0878110001Medicare NSC