Individual
CARLA RUDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1851 OLD US 66, EDGEWOOD, NM 87015-7200
(505) 286-2396
Mailing address
1851 OLD US 66, EDGEWOOD, NM 87015-7200
(505) 286-2396
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
A-1770-13
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104182328
—
NC
Enumeration date
04/02/2012
Last updated
05/04/2020
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