Healthcare Provider Details

I. General information

NPI: 1992741631
Provider Name (Legal Business Name): PEDRO RUGGERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 N LEONA ST
SAN ANTONIO TX
78207-3110
US

IV. Provider business mailing address

3031 IH 10 W
SAN ANTONIO TX
78201-5159
US

V. Phone/Fax

Practice location:
  • Phone: 210-731-1300
  • Fax: 210-738-8025
Mailing address:
  • Phone: 210-731-1300
  • Fax: 210-738-8025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberF0302
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: