Provider Demographics
NPI:1427499904
Name:ADAMS, JAN RUDALGO (MD)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:RUDALGO
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6261 VIEW CREST DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-3719
Mailing Address - Country:US
Mailing Address - Phone:510-530-4688
Mailing Address - Fax:510-530-4689
Practice Address - Street 1:17150 EUCLID ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4092
Practice Address - Country:US
Practice Address - Phone:714-918-5184
Practice Address - Fax:714-918-5172
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA51004208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery