# BONEBUILDERS MEDICAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356401566
- **Authorized official:** DR. CHARLES N RUDOLPH MD (PRESIDENT)
- **Authorized official phone:** (858) 678-0455

## Contact information

- **Practice address:** 4150 REGENTS PARK ROW STE 321, LA JOLLA, CA 92037-9124
- **Practice address phone:** (858) 678-0455
- **Practice address fax:** (858) 678-0391
- **Mailing address:** 4510 EXECUTIVE DRIVE, SUITE 125, SAN DIEGO, CA 92121
- **Mailing address phone:** (858) 678-0455
- **Mailing address fax:** (858) 678-0391

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | G60659 | CA | Yes |

## Other

- **Enumeration date:** 12/11/2006
- **Last updated:** 01/07/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1356401566 | — | CA |