Provider Demographics
NPI:1316097199
Name:RUDZIK, SUSIE ELAINE (OT)
Entity type:Individual
Prefix:MRS
First Name:SUSIE
Middle Name:ELAINE
Last Name:RUDZIK
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24012 CALLE DE LA PLATA
Mailing Address - Street 2:STE. 355
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3621
Mailing Address - Country:US
Mailing Address - Phone:949-916-1654
Mailing Address - Fax:949-916-1658
Practice Address - Street 1:24012 CALLE DE LA PLATA
Practice Address - Street 2:STE. 355
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3621
Practice Address - Country:US
Practice Address - Phone:949-916-1654
Practice Address - Fax:949-916-1658
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 6041174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACT-0029130OtherCAL OPTIMA