Basic Information
| Provider Information | |||||||||
| NPI: | 1740958073 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUDAS | ||||||||
| FirstName: | FRANZ | ||||||||
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| Mailing Information | |||||||||
| Address1: | 644 ANTIQUITY DR | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945344050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7073867472 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1143 MISSOURI ST | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945336007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074359911 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2021 | ||||||||
| LastUpdateDate: | 09/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 167G00000X | Y | Nursing Service Providers | Licensed Psychiatric Technician |
No ID Information.