Healthcare Provider Details

I. General information

NPI: 1598067555
Provider Name (Legal Business Name): RIGO KURT BRUECK PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2010
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 N SANTA FE AVE
VISTA CA
92084-1651
US

IV. Provider business mailing address

533 2ND ST STE 210
ENCINITAS CA
92024-3558
US

V. Phone/Fax

Practice location:
  • Phone: 760-846-4688
  • Fax:
Mailing address:
  • Phone: 760-846-4688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number25588
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 48997
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: