Healthcare Provider Details

I. General information

NPI: 1104961663
Provider Name (Legal Business Name): DR. ALBERT G RUEZGA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 E CALVADA BLVD 1
PAHRUMP NV
89048-5880
US

IV. Provider business mailing address

2340 E CALVADA BLVD 1
PAHRUMP NV
89048-5880
US

V. Phone/Fax

Practice location:
  • Phone: 775-751-5888
  • Fax: 775-751-1573
Mailing address:
  • Phone: 775-751-5888
  • Fax: 775-751-1573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4065
License Number StateNV

VIII. Authorized Official

Name: ALBERT G RUEZGA
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 775-751-5888