Provider Demographics
NPI:1275772444
Name:WESTBROOK, RUBY J
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:J
Last Name:WESTBROOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 PARK AVE APT 110C
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-1362
Mailing Address - Country:US
Mailing Address - Phone:440-285-4838
Mailing Address - Fax:144-028-5483
Practice Address - Street 1:397 PARK AVE APT 110C
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-1362
Practice Address - Country:US
Practice Address - Phone:440-285-4838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCSW6082347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2880100Medicaid