Provider Demographics
NPI:1245636786
Name:RUDOLPH MULTI SPECIALTY MEDICAL GROUP
Entity type:Organization
Organization Name:RUDOLPH MULTI SPECIALTY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:909-483-3530
Mailing Address - Street 1:435 ORANGE SHOW LN STE 208
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-2032
Mailing Address - Country:US
Mailing Address - Phone:909-483-3530
Mailing Address - Fax:909-380-7741
Practice Address - Street 1:435 ORANGE SHOW LN STE 208
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-2032
Practice Address - Country:US
Practice Address - Phone:909-483-3530
Practice Address - Fax:909-380-7741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty