Healthcare Provider Details

I. General information

NPI: 1518907401
Provider Name (Legal Business Name): CHARLES RUGGEROLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7020 SMOKE RANCH RD STE 150
LAS VEGAS NV
89128-3111
US

IV. Provider business mailing address

7020 SMOKE RANCH RD STE 150
LAS VEGAS NV
89128-3111
US

V. Phone/Fax

Practice location:
  • Phone: 702-258-1601
  • Fax: 702-870-1995
Mailing address:
  • Phone: 702-258-1601
  • Fax: 702-870-1995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number9343
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: