Provider Demographics
NPI:1891552212
Name:RUGGERI, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:RUGGERI
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 1:26418 N ARROYO WAY
Mailing Address - Street 2:
Mailing Address - City:RIO VERDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85263-7000
Mailing Address - Country:US
Mailing Address - Phone:314-605-2502
Mailing Address - Fax:
Practice Address - Street 1:26418 N ARROYO WAY
Practice Address - Street 2:
Practice Address - City:RIO VERDE
Practice Address - State:AZ
Practice Address - Zip Code:85263-7000
Practice Address - Country:US
Practice Address - Phone:314-605-2502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer