Provider Demographics
NPI:1689896516
Name:RUDNICK, ALICE ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:ANN
Last Name:RUDNICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11980 SAN VICENTE BLVD
Mailing Address - Street 2:SUITE 711
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-1028
Mailing Address - Country:US
Mailing Address - Phone:310-826-4088
Mailing Address - Fax:310-826-7823
Practice Address - Street 1:11980 SAN VICENTE BLVD
Practice Address - Street 2:SUITE 711
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-1028
Practice Address - Country:US
Practice Address - Phone:310-826-4088
Practice Address - Fax:310-826-7823
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG585742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry