| Kenneth L. Nudleman, M.d., Inc. | |
|
801 N. Tustin Ave. Suite 304 Santa Ana CA 92705-3608 | |
| (714) 542-7996 | |
| (714) 542-3011 |
| Full Name | Kenneth L. Nudleman, M.d., Inc. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 801 N. Tustin Ave., Santa Ana, California |
| Authorized Official Name and Position | Kenneth Leonard Nudleman (OWNER/PRESIDENT) |
| Authorized Official Contact | 7145427996 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenneth L. Nudleman, M.d., Inc. 4790 Irvine Blvd. Suite 105-241 Irvine CA 92620-1998 Ph: (714) 542-7996 | Kenneth L. Nudleman, M.d., Inc. 801 N. Tustin Ave. Suite 304 Santa Ana CA 92705-3608 Ph: (714) 542-7996 |
| NPI Number | 1083951016 |
|---|---|
| Provider Enumeration Date | 01/10/2013 |
| Last Update Date | 01/10/2013 |
| Medicare PECOS PAC ID | 1951549229 |
|---|---|
| Medicare Enrollment ID | O20130528000194 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083951016 | NPI | - | NPPES |
| 00G374070 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | G37407 (California) | Primary |
| Provider Name | Kenneth L Nudleman |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1558324145 PECOS PAC ID: 5496805103 Enrollment ID: I20090617000652 |
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