Active NPI
David Maynard Rudesill
- Mental Health Counselor
- Los Angeles, CA
National Provider Identifier
1912289661
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 33575
- Practice address
- 11363 Herbert St
Los Angeles, CA 90066-5461 - Phone
- (831) 535-3491
- NPI assigned
- Sep 19, 2011
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 33575 | CA | Primary |
Addresses
Primary practice location
11363 Herbert St
Los Angeles, CA 90066-5461
Mailing address
11363 Herbert St
Los Angeles, CA 90066-5461
Phone (831) 535-3491
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 |
|---|---|---|---|
| 33575 | CA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370390400000",
"number": "1912289661",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11363 HERBERT ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900665461",
"telephone_number": "831-535-3491"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11363 HERBERT ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900665461",
"telephone_number": "831-535-3491"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDESILL",
"first_name": "DAVID",
"middle_name": "MAYNARD",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-19",
"last_updated": "2013-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "33575",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.