Provider Demographics
NPI:1497329627
Name:RUGIRA, PAUL (CNP)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:RUGIRA
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 GRANDE BLVD SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1755
Mailing Address - Country:US
Mailing Address - Phone:505-896-7100
Mailing Address - Fax:
Practice Address - Street 1:2300 GRANDE BLVD SE STE 4045
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1755
Practice Address - Country:US
Practice Address - Phone:505-896-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1038058363LF0000X
NM66685363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily