Basic Information
| Provider Information | |||||||||
| NPI: | 1114224540 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RENDLA | ||||||||
| FirstName: | SUDHAKAR | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 45680 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941450680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306262787 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4341 GOLDEN CENTER DR | ||||||||
| Address2: | |||||||||
| City: | PLACERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956676260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306261144 | ||||||||
| FaxNumber: | 5056096701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2011 | ||||||||
| LastUpdateDate: | 02/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A130225 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.