Active NPI
Risa Booc Tudtud
- Multi-Specialty Clinic/Center
- Santee, CA
National Provider Identifier
1003176801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Multi-Specialty Clinic/Center
- License
- 748247
- Practice address
- 10760 N Magnolia Ave
8B
Santee, CA 92071-1292 - Phone
- (858) 537-7007
- NPI assigned
- May 25, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Multi-Specialty Clinic/Center | 261QM1300X | 748247 | CA | Primary |
Addresses
Primary practice location
10760 N Magnolia Ave
8B
Santee, CA 92071-1292
Mailing address
10760 N Magnolia Ave
8B
Santee, CA 92071-1292
Phone (858) 537-7007
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 748247 | CA | MD | Multi-Specialty Clinic/Center |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1337904000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1337904000000",
"number": "1003176801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10760 N MAGNOLIA AVE",
"address_2": "8B",
"city": "SANTEE",
"state": "CA",
"postal_code": "920711292",
"telephone_number": "858-537-7007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10760 N MAGNOLIA AVE",
"address_2": "8B",
"city": "SANTEE",
"state": "CA",
"postal_code": "920711292",
"telephone_number": "858-537-7007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TUDTUD",
"first_name": "RISA",
"middle_name": "BOOC",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-05-25",
"last_updated": "2012-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "261QM1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Multi-Specialty",
"state": "CA",
"license": "748247",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santee, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.