Active NPI
Andrew Rudd
- Marriage & Family Therapist
- Apple Valley, CA
National Provider Identifier
1417414749
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 111910
- Practice address
- 20786 Bear Valley Rd Ste I
Apple Valley, CA 92308-6909 - Phone
- (805) 285-2696
- NPI assigned
- Feb 22, 2019
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 111910 | CA | Primary |
Addresses
Primary practice location
20786 Bear Valley Rd Ste I
Apple Valley, CA 92308-6909
Mailing address
16040 Greyrock St
Victorville, CA 92395-8628
Phone (909) 560-1934
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240501002409 | CA | Practitioner - Marriage and Family Therapist | 1254770266 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 111910 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1550793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1754956800000",
"number": "1417414749",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16040 GREYROCK ST",
"city": "VICTORVILLE",
"state": "CA",
"postal_code": "923958628",
"telephone_number": "909-560-1934"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20786 BEAR VALLEY RD STE I",
"city": "APPLE VALLEY",
"state": "CA",
"postal_code": "923086909",
"telephone_number": "805-285-2696"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDD",
"first_name": "ANDREW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-02-22",
"last_updated": "2025-08-12",
"certification_date": "2025-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "111910",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Apple Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.