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General NPI Number Information
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NPI Number | 1255560454
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Entity Type | Organization
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Legal Business Name | MESA FAMILY PRACTICE/JACOBO A. RUYBAL M.D.
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Dates
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Enumeration Date | 07/08/2009
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Last Update Date | 12/27/2010
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Provider Practice Location Address
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Address Line | 2231 N 7TH ST
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-7434
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Country | US
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Telephone | 970-243-1331
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Fax | 970-243-9190
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Provider Business Mailing Address
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Address Line | 2231 N 7TH ST
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-7434
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Country | US
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Telephone | 970-243-1331
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Fax | 970-243-9190
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | TAMARA RUYBAL
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Credential |
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Telephone | 970-243-1331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 24283
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License Number State | CO
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