Provider Demographics
NPI:1689069114
Name:CADUNGOG, RUVESPIERE
Entity Type:Individual
Prefix:
First Name:RUVESPIERE
Middle Name:
Last Name:CADUNGOG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3884 HAMPTON HILLS DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-3839
Mailing Address - Country:US
Mailing Address - Phone:504-729-7619
Mailing Address - Fax:
Practice Address - Street 1:3884 HAMPTON HILLS DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-3839
Practice Address - Country:US
Practice Address - Phone:504-729-7619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL12000052558171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor