Healthcare Provider Details

I. General information

NPI: 1255462677
Provider Name (Legal Business Name): SARAH COOK RUGGERA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9265 DOWDY DRIVE SUITE 225
SAN DIEGO CA
92126
US

IV. Provider business mailing address

10660 LAKECREST PT
SAN DIEGO CA
92131
US

V. Phone/Fax

Practice location:
  • Phone: 858-735-1139
  • Fax:
Mailing address:
  • Phone: 858-735-1139
  • Fax: 858-566-0689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberMFC31998
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: