Provider Demographics
NPI:1811205180
Name:RUGGIERO, FABRIZIO
Entity Type:Individual
Prefix:MR
First Name:FABRIZIO
Middle Name:
Last Name:RUGGIERO
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 1:5816 E JOSHUA TREE LN
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-3446
Mailing Address - Country:US
Mailing Address - Phone:480-209-8879
Mailing Address - Fax:
Practice Address - Street 1:2168 E WILLIAMS FIELD RD
Practice Address - Street 2:SUITE 108
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-0741
Practice Address - Country:US
Practice Address - Phone:480-899-9970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1012I156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician