Healthcare Provider Details

I. General information

NPI: 1720139942
Provider Name (Legal Business Name): STEVEN ALEXANDER RUGALA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4404 DRIFTWOOD AVE NW
ALBUQUERQUE NM
87114-5033
US

IV. Provider business mailing address

4404 DRIFTWOOD AVE NW
ALBUQUERQUE NM
87114-5033
US

V. Phone/Fax

Practice location:
  • Phone: 505-890-1696
  • Fax:
Mailing address:
  • Phone: 505-890-1696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number805
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: