Provider Demographics
NPI:1659128478
Name:RUYBAL, JEANETTE MICHELE (ABO)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:MICHELE
Last Name:RUYBAL
Suffix:
Gender:F
Credentials:ABO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 SUNNYSIDE LN
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2733
Mailing Address - Country:US
Mailing Address - Phone:719-588-2727
Mailing Address - Fax:719-587-3809
Practice Address - Street 1:3333 CLARK ST
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2050
Practice Address - Country:US
Practice Address - Phone:719-587-3803
Practice Address - Fax:719-587-3809
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician