Healthcare Provider Details

I. General information

NPI: 1336690569
Provider Name (Legal Business Name): ROBIN RUGNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2403 PROFESSIONAL DR
SANTA ROSA CA
95403-3007
US

IV. Provider business mailing address

2403 PROFESSIONAL DR
SANTA ROSA CA
95403-3007
US

V. Phone/Fax

Practice location:
  • Phone: 707-565-7460
  • Fax: 707-565-7488
Mailing address:
  • Phone: 707-565-7460
  • Fax: 707-565-7488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: