1073640975 NPI number — SARAH E RUYBALID RN

Table of content: SARAH E RUYBALID RN (NPI 1073640975)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073640975 NPI number — SARAH E RUYBALID RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUYBALID
Provider First Name:
SARAH
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
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:
1073640975
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:
130 CARRILLON LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUEBLO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81005-3352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-583-4351
Provider Business Mailing Address Fax Number:
719-583-4439

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 CENTRAL MAIN ST
Provider Second Line Business Practice Location Address:
PUEBLO CITY-COUNTY HEALTH DEPARTMENT
Provider Business Practice Location Address City Name:
PUEBLO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81003-4212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-583-4351
Provider Business Practice Location Address Fax Number:
719-583-4439
Provider Enumeration Date:
02/27/2007

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: 163WA2000X , with the licence number:  49179 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 07491798 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com