Provider Demographics
NPI:1598067555
Name:BRUECK, RIGO KURT (PHD)
Entity Type:Individual
Prefix:DR
First Name:RIGO
Middle Name:KURT
Last Name:BRUECK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 2ND ST
Mailing Address - Street 2:STE 210
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3558
Mailing Address - Country:US
Mailing Address - Phone:760-846-4688
Mailing Address - Fax:
Practice Address - Street 1:2405 N SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-1651
Practice Address - Country:US
Practice Address - Phone:760-846-4688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-24
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25588103TA0400X
CAMFC 48997106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist