Provider Demographics
NPI:1811940190
Name:REDULA, LUDVOICO K JR (MD)
Entity type:Individual
Prefix:DR
First Name:LUDVOICO
Middle Name:K
Last Name:REDULA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:VIC
Other - Middle Name:K
Other - Last Name:REDULA
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:625 JOHN KAMPS WAY
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:CA
Mailing Address - Zip Code:95366-9471
Mailing Address - Country:US
Mailing Address - Phone:310-384-0909
Mailing Address - Fax:209-557-1685
Practice Address - Street 1:4125 BANGS AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-8713
Practice Address - Country:US
Practice Address - Phone:209-557-1749
Practice Address - Fax:209-557-1685
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63193208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A669740Medicaid
CABR6148060OtherDEA NUMBER