Provider Demographics
NPI:1952469173
Name:RUDNICK, NINA
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:RUDNICK
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 1:738 ALCATRAZ AVE
Mailing Address - Street 2:#1
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1040
Mailing Address - Country:US
Mailing Address - Phone:510-684-7541
Mailing Address - Fax:
Practice Address - Street 1:738 ALCATRAZ AVE
Practice Address - Street 2:#1
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1040
Practice Address - Country:US
Practice Address - Phone:510-684-7541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent