Healthcare Provider Details

I. General information

NPI: 1912724949
Provider Name (Legal Business Name): RICHARD SEMARIZA RUGANIRWA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 SOUTHPOINT DR
LEXINGTON KY
40515-4799
US

IV. Provider business mailing address

433 SOUTHPOINT DR
LEXINGTON KY
40515-4799
US

V. Phone/Fax

Practice location:
  • Phone: 85-936-8482
  • Fax:
Mailing address:
  • Phone: 85-936-8482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: