Healthcare Provider Details

I. General information

NPI: 1053416891
Provider Name (Legal Business Name): ROBERTA RAMONA CARRUBBA LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7171 BOWLING DR SUITE 300 SOUTH CITY HEALTH CENTER DHHS
SACRAMENTO CA
95823
US

IV. Provider business mailing address

1453 SHERWOOD AVE
SACRAMENTO CA
95822
US

V. Phone/Fax

Practice location:
  • Phone: 916-875-0802
  • Fax: 916-876-5857
Mailing address:
  • Phone: 916-875-0802
  • Fax: 916-876-5857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN58142
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: