Healthcare Provider Details

I. General information

NPI: 1003833690
Provider Name (Legal Business Name): PAUL JOSEPH RUGGIANO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1793 SW 3RD AVE
MIAMI FL
33129-1492
US

IV. Provider business mailing address

3800 SW 60TH AVE
MIAMI FL
33155-5015
US

V. Phone/Fax

Practice location:
  • Phone: 305-858-5880
  • Fax: 305-858-5877
Mailing address:
  • Phone: 305-668-8629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCH6420
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: