Provider Demographics
NPI:1720139942
Name:RUGALA, STEVEN ALEXANDER (PHD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ALEXANDER
Last Name:RUGALA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4404 DRIFTWOOD AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5033
Mailing Address - Country:US
Mailing Address - Phone:505-890-1696
Mailing Address - Fax:
Practice Address - Street 1:4404 DRIFTWOOD AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5033
Practice Address - Country:US
Practice Address - Phone:505-890-1696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM805103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM56800568Medicaid