| Doctor Name: | CARLA RUDOLPH |
| NPI Number: | 1104182328 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | D.O. |
| License Number: | A-1770-13 |
| Business Practice Address: | 363 Pinon Creek Rd Se Albuquerque, NM - 871233963 |
| Business Phone Number: | 5406410271 |
| Business Fax Number: | |
| Mailing Address: | 363 Pinon Creek Rd Se, ALBUQUERQUE |
| State: | NM |
| Postal Code: | 871233963 |
| Phone Number: | 5406410271 |
| Fax Number: | |
| NPI Enumeration Date: | 04/02/2012 |
| NPI Last Update Date: | 04/29/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | A-1770-13 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |