1053416891 NPI number — MISS ROBERTA RAMONA CARRUBBA LVN

Table of content: MISS ROBERTA RAMONA CARRUBBA LVN (NPI 1053416891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053416891 NPI number — MISS ROBERTA RAMONA CARRUBBA LVN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARRUBBA
Provider First Name:
ROBERTA
Provider Middle Name:
RAMONA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LVN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053416891
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1453 SHERWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-875-0802
Provider Business Mailing Address Fax Number:
916-876-5857

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7171 BOWLING DR
Provider Second Line Business Practice Location Address:
SUITE 300 SOUTH CITY HEALTH CENTER DHHS
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-875-0802
Provider Business Practice Location Address Fax Number:
916-876-5857
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164X00000X , with the licence number:  VN58142 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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