| Doctor Name: | MRS. RISA BOOC TUDTUD |
| NPI Number: | 1003176801 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 748247 |
| Business Practice Address: | 10760 N Magnolia Ave 8b Santee, CA - 920711292 |
| Business Phone Number: | 8585377007 |
| Business Fax Number: | |
| Mailing Address: | 10760 N Magnolia Ave, 8b SANTEE |
| State: | CA |
| Postal Code: | 920711292 |
| Phone Number: | 8585377007 |
| Fax Number: | |
| NPI Enumeration Date: | 05/25/2012 |
| NPI Last Update Date: | 05/25/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | 748247 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |