Provider Demographics
NPI:1265719488
Name:RUGG, KIERSTEN KAY (MED)
Entity type:Individual
Prefix:MRS
First Name:KIERSTEN
Middle Name:KAY
Last Name:RUGG
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 SEASIDE CT
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-4221
Mailing Address - Country:US
Mailing Address - Phone:803-524-9678
Mailing Address - Fax:
Practice Address - Street 1:1133 COLOMA WAY
Practice Address - Street 2:AEGIS MEDICAL SYSTEMS, INC
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661
Practice Address - Country:US
Practice Address - Phone:818-206-0306
Practice Address - Fax:818-206-0381
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)