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NPI Code Detail

MEDICARE: L E RUCKSTUHL INC

MEDICARE: L E RUCKSTUHL INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPY0462NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265544126
Entity Type Code : Organization
Provider Name (Legal Business Name) : L E RUCKSTUHL INC
Provider Business Mailing Address
First Line : 5421 KIETZKE LANE
Second Line : SUITE 202
City : RENO
State : NV
Zip : 89511-1088
Country : US
Telephone Number : 775-787-7028
Fax Number : 877-738-0730
Provider Business Practice Location Address
First Line : 5421 KIETZKE LN
Second Line : SUITE 202
City : RENO
State : NV
Zip : 89511-1088
Country : US
Telephone Number : 775-787-7028
Fax Number : 877-738-0730
Authorized Official
Title or Position : PRESIDENT
Name : DR. LIONEL EDWARD RUCKSTUHL JR.
Credential : PH.D.
Telephone Number : 775-787-7028
Provider Enumeration Date : 08/31/2006
Last Update Date : 02/11/2009

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Directions to “L E RUCKSTUHL INC ” Practice Location

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