Basic Information
| Provider Information | |||||||||
| NPI: | 1003297979 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NKDHC RUDNITSKY PLLC | ||||||||
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| OtherOrganizationName: | NKDHC, PLLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3003 N CENTRAL AVE STE 400 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850122929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023513015 | ||||||||
| FaxNumber: | 6022243315 | ||||||||
| Practice Location | |||||||||
| Address1: | 2425 N LAMB BLVD STE 120 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891155499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028517766 | ||||||||
| FaxNumber: | 7028517760 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2015 | ||||||||
| LastUpdateDate: | 06/16/2015 | ||||||||
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| AuthorizedOfficialLastName: | ESCOBEDO | ||||||||
| AuthorizedOfficialFirstName: | ADONIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6023513015 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 1265831432 | 05 | NV | MEDICAID |