Provider Demographics
NPI:1134972847
Name:RUGELEY-VALLE, PARKER (EDD)
Entity type:Individual
Prefix:DR
First Name:PARKER
Middle Name:
Last Name:RUGELEY-VALLE
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 SERENO DR
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-7001
Mailing Address - Country:US
Mailing Address - Phone:209-565-1176
Mailing Address - Fax:
Practice Address - Street 1:515 13TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2437
Practice Address - Country:US
Practice Address - Phone:209-662-9820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician