Provider Demographics
NPI:1053040485
Name:DUDANI, RITU
Entity type:Individual
Prefix:
First Name:RITU
Middle Name:
Last Name:DUDANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 E ARQUES AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-5419
Mailing Address - Country:US
Mailing Address - Phone:408-720-1700
Mailing Address - Fax:408-720-6900
Practice Address - Street 1:1208 E ARQUES AVE STE 115
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-5419
Practice Address - Country:US
Practice Address - Phone:408-720-1700
Practice Address - Fax:408-720-6900
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302210261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFX865AOtherPHYSICAL THERAPY
CA1679755136Medicaid