Provider Demographics
NPI:1073640975
Name:RUYBALID, SARAH E (RN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:RUYBALID
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:130 CARRILLON LN
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-3352
Mailing Address - Country:US
Mailing Address - Phone:719-583-4351
Mailing Address - Fax:719-583-4439
Practice Address - Street 1:151 CENTRAL MAIN ST
Practice Address - Street 2:PUEBLO CITY-COUNTY HEALTH DEPARTMENT
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-4212
Practice Address - Country:US
Practice Address - Phone:719-583-4351
Practice Address - Fax:719-583-4439
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO49179163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07491798Medicaid