Provider Demographics
NPI:1053416891
Name:CARRUBBA, ROBERTA RAMONA (LVN)
Entity type:Individual
Prefix:MISS
First Name:ROBERTA
Middle Name:RAMONA
Last Name:CARRUBBA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1453 SHERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822
Mailing Address - Country:US
Mailing Address - Phone:916-875-0802
Mailing Address - Fax:916-876-5857
Practice Address - Street 1:7171 BOWLING DR
Practice Address - Street 2:SUITE 300 SOUTH CITY HEALTH CENTER DHHS
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823
Practice Address - Country:US
Practice Address - Phone:916-875-0802
Practice Address - Fax:916-876-5857
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN58142164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse