Provider Demographics
NPI:1558402065
Name:RUGGIERO, DANIELLE ROSE (RPA-C)
Entity type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:ROSE
Last Name:RUGGIERO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25820 LUCILLE AVENUE, SUITE 203
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717
Mailing Address - Country:US
Mailing Address - Phone:310-483-1241
Mailing Address - Fax:
Practice Address - Street 1:2244 PACIFIC COAST HIGHWAY SUITE 203
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717
Practice Address - Country:US
Practice Address - Phone:310-483-1241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011496-1363AS0400X
CAPA62193363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical