Provider Demographics
NPI:1508903790
Name:MAEZ, RUBY JOY (RN)
Entity Type:Individual
Prefix:MRS
First Name:RUBY
Middle Name:JOY
Last Name:MAEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:RUBY
Other - Middle Name:JOY
Other - Last Name:DURAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3713 SHEFFIELD LN
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-3269
Mailing Address - Country:US
Mailing Address - Phone:719-583-4362
Mailing Address - Fax:719-583-4439
Practice Address - Street 1:151 CENTRAL MAIN ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-4212
Practice Address - Country:US
Practice Address - Phone:719-583-4362
Practice Address - Fax:719-583-4439
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30194163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07301948Medicaid