Healthcare Provider Details

I. General information

NPI: 1992941595
Provider Name (Legal Business Name): SANDRA RUVALCABA M.A., BACB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA RUVALCABA M.A., BACB

II. Dates (important events)

Enumeration Date: 01/02/2009
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2760 FIELDSTONE RD
COLORADO SPRINGS CO
80919-3100
US

IV. Provider business mailing address

2760 FIELDSTONE RD
COLORADO SPRINGS CO
80919-3100
US

V. Phone/Fax

Practice location:
  • Phone: 719-203-6903
  • Fax: 719-203-6904
Mailing address:
  • Phone: 719-203-6903
  • Fax: 719-203-6904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number1084661
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1084661
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: