Healthcare Provider Details

I. General information

NPI: 1720550197
Provider Name (Legal Business Name): LEONA RUEGG RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2018
Last Update Date: 12/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 MARSHALL ST
REDWOOD CITY CA
94063-2033
US

IV. Provider business mailing address

185 SYLVAN WAY
BOULDER CREEK CA
95006-9625
US

V. Phone/Fax

Practice location:
  • Phone: 650-299-2270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number23813
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: