Provider Demographics
NPI:1932202280
Name:SERGIO J RYBKA MD PC
Entity Type:Organization
Organization Name:SERGIO J RYBKA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMENDAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-887-5542
Mailing Address - Street 1:1031 N THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-4597
Mailing Address - Country:US
Mailing Address - Phone:575-887-5542
Mailing Address - Fax:575-885-0082
Practice Address - Street 1:1031 N THOMAS ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220
Practice Address - Country:US
Practice Address - Phone:575-887-5542
Practice Address - Fax:575-885-0082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM82-301208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM9712Medicaid