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Andrea Christine Rudolph

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

100 Ucla Medical Plz, Suite 760, Los Angeles, CA 90095-0001

PECOS Enrollment

This provider is enrolled in PECOS as ANDREA RUDOLPH.

Based on the most recent information from CMS, provider Andrea Christine Rudolph is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 11 days ago.

Profile Details

Provider ID
1811109986
Provider Type
Individual
Full Name
Rudolph, Andrea Christine
Title
Ms.
Credential
RN, MSN, ACNP

Gender
Female
Sole Proprietor
No
Enumeration Date
5/3/2007
Last Updated
7/8/2007

Contact Information

Practice Location

100 Ucla Medical Plz, Suite 760, Los Angeles, CA 90095-0001

(310) 264-7246

(310) 882-7005

Mailing Location

11663 Gorham Ave, Apt. #8, Los Angeles, CA 90049-4749

(310) 207-6989

(310) 882-7005

Provider Taxonomies

Code	Description	License
Code 363LA2100X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 13834 California

Andrea Christine Rudolph

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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