Haydee Rudholm, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA 13119 Issued in CA

Practice address

1701 Zonal Ave
Los Angeles, CA 90033-1065

Phone

(323) 223-6146

Fax

(323) 223-6399

NPI assigned

Nov 22, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1730254996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5935 PLAYA VISTA DR APT 102",
            "city": "PLAYA VISTA",
            "state": "CA",
            "postal_code": "900942131",
            "telephone_number": "323-841-0955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 ZONAL AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900331065",
            "telephone_number": "323-223-6146",
            "fax_number": "323-223-6399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDHOLM",
        "first_name": "HAYDEE",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA 13119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rudell Gary S. Jacinto, DMD, Inc.
• Erin Marissa Ruder, AMFT
• Bradley Lewis Ruderman
• David Maynard Rudesill
• Meredith Leigh Rudhman
• Andrew Gene Rudikoff, MD
• Lawrence S. Rudin, PH.D.
• Michael Irvin Rudin
• Caroline Rudio, RN
• Desiree Renee Rudisel, M.A., CCC-SLP

• Physician Assistant in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.