Healthcare Provider Details

I. General information

NPI: 1568392603
Provider Name (Legal Business Name): ISADORA P RUEBEN HOME HEALTH AIDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DORA P RUEBEN HOME HEALTH AIDE

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 POTTERY RD
SEAMA NM
87007-1051
US

IV. Provider business mailing address

PO BOX 432
NEW LAGUNA NM
87038-0432
US

V. Phone/Fax

Practice location:
  • Phone: 505-552-6104
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: