Provider Demographics
NPI:1891780425
Name:ALEGRIA, RUDOLPHO J (MD)
Entity Type:Individual
Prefix:DR
First Name:RUDOLPHO
Middle Name:J
Last Name:ALEGRIA
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 1:82420 MILES AVE
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-4250
Mailing Address - Country:US
Mailing Address - Phone:760-342-3336
Mailing Address - Fax:760-342-3610
Practice Address - Street 1:82420 MILES AVE
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-4250
Practice Address - Country:US
Practice Address - Phone:760-342-3336
Practice Address - Fax:760-342-3610
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37049207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A370490Medicaid
ZZZ01522ZMedicare ID - Type Unspecified
CA00A370491Medicare ID - Type Unspecified
CA00A370490Medicaid