Healthcare Provider Details

I. General information

NPI: 1164748455
Provider Name (Legal Business Name): FRANCISCO O RUGAMA D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 05/27/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4711 W ASHLAN AVE
FRESNO CA
93722-4307
US

IV. Provider business mailing address

4711 W ASHLAN AVE
FRESNO CA
93722-4307
US

V. Phone/Fax

Practice location:
  • Phone: 559-203-6660
  • Fax:
Mailing address:
  • Phone: 559-203-6660
  • Fax: 559-558-5958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number59503
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: