Healthcare Provider Details

I. General information

NPI: 1265719488
Provider Name (Legal Business Name): KIERSTEN KAY RUGG M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 COLOMA WAY AEGIS MEDICAL SYSTEMS, INC
ROSEVILLE CA
95661
US

IV. Provider business mailing address

926 SEASIDE CT
VENTURA CA
93001-4221
US

V. Phone/Fax

Practice location:
  • Phone: 818-206-0306
  • Fax: 818-206-0381
Mailing address:
  • Phone: 803-524-9678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: