1770609224 NPI number — MELODY A RUDOLPH BS, CMT, CST, CIMI

Table of content: NIREIDA PINA LOPES (NPI 1689307530)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770609224 NPI number — MELODY A RUDOLPH BS, CMT, CST, CIMI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUDOLPH
Provider First Name:
MELODY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BS, CMT, CST, CIMI
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770609224
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9968 VIA LESLIE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTEE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92071-1547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-794-9002
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10201 MISSION GORGE RD
Provider Second Line Business Practice Location Address:
SUITE 'A'
Provider Business Practice Location Address City Name:
SANTEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92071-3027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-794-9002
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  51723 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com