Healthcare Provider Details

I. General information

NPI: 1053151373
Provider Name (Legal Business Name): JUSTIN RUGANZA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2024
Last Update Date: 05/27/2024
Certification Date: 05/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8288 BRIGANTINE CT APT 61
WEST CHESTER OH
45069-8730
US

IV. Provider business mailing address

8288 BRIGANTINE CT APT 61
WEST CHESTER OH
45069-8730
US

V. Phone/Fax

Practice location:
  • Phone: 513-255-3960
  • Fax:
Mailing address:
  • Phone: 513-255-3960
  • 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: