Provider Demographics
NPI:1336368331
Name:RUDENBERG, MURRAY BRIAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MURRAY
Middle Name:BRIAN
Last Name:RUDENBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2423 CAMINO DEL RIO S STE 106
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3734
Mailing Address - Country:US
Mailing Address - Phone:858-509-7575
Mailing Address - Fax:858-794-0370
Practice Address - Street 1:2423 CAMINO DEL RIO S STE 106
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3734
Practice Address - Country:US
Practice Address - Phone:858-729-0692
Practice Address - Fax:858-638-1576
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 12844103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP12844Medicare PIN