Individual
DR. KRISTIARSI RUDITO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10800 MAGNOLIA AVE, RIVERSIDE, CA 92505-3043
(951) 353-5569
Mailing address
11711 COLLETT AVE, RIVERSIDE, CA 92505-3766
(951) 785-5534
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
A75290
CA
Other
Enumeration date
12/20/2006
Last updated
08/16/2007
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