Organization
BONEBUILDERS MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES N RUDOLPH MD (PRESIDENT)
(858) 678-0455
Entity
Organization
Contact information
Practice address
4150 REGENTS PARK ROW STE 321, LA JOLLA, CA 92037-9124
(858) 678-0455
(858) 678-0391
Mailing address
4510 EXECUTIVE DRIVE, SUITE 125, SAN DIEGO, CA 92121
(858) 678-0455
(858) 678-0391
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
G60659
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356401566
—
CA
Enumeration date
12/11/2006
Last updated
01/07/2022
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