Healthcare Provider Details

I. General information

NPI: 1376356725
Provider Name (Legal Business Name): RICHARD RUGABISHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1359 HERITAGE LN
WAITE PARK MN
56387-4510
US

IV. Provider business mailing address

1359 HERITAGE LN
WAITE PARK MN
56387-4510
US

V. Phone/Fax

Practice location:
  • Phone: 515-473-8067
  • Fax:
Mailing address:
  • Phone: 515-473-8067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: