Healthcare Provider Details

I. General information

NPI: 1306204201
Provider Name (Legal Business Name): STANLEY W RUGGLES MD A PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6450 COYLE AVE SUITE 3
CARMICHAEL CA
95608-0313
US

IV. Provider business mailing address

6450 COYLE AVE SUITE 3
CARMICHAEL CA
95608-0313
US

V. Phone/Fax

Practice location:
  • Phone: 916-621-6740
  • Fax: 916-903-7255
Mailing address:
  • Phone: 916-621-6740
  • Fax: 916-903-7255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: STANLEY W RUGGLES
Title or Position: OWNER
Credential: MD
Phone: 916-621-6740