Provider Demographics
NPI:1093146243
Name:RUYBAL, ANDREA COURTNEY (RN)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:COURTNEY
Last Name:RUYBAL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 COURAGE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6717
Mailing Address - Country:US
Mailing Address - Phone:707-750-3000
Mailing Address - Fax:707-673-5988
Practice Address - Street 1:2101 COURAGE DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6717
Practice Address - Country:US
Practice Address - Phone:707-750-3000
Practice Address - Fax:707-673-5988
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA839194163WG0000X, 163WP0808X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WS0200XNursing Service ProvidersRegistered NurseSchool