Healthcare Provider Details

I. General information

NPI: 1396452512
Provider Name (Legal Business Name): JOSHUA S RUGG SUDTP13304
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2022
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 JULIESSE AVE
SACRAMENTO CA
95815-1803
US

IV. Provider business mailing address

PO BOX 6021
AUBURN CA
95604-6021
US

V. Phone/Fax

Practice location:
  • Phone: 530-885-1917
  • Fax:
Mailing address:
  • Phone: 530-878-5166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13304
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: