Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 82-301 | NM |
NPI | 1023111374 |
---|---|
Provider Name | Sergio Jose Rybka |
First Address | Carlsbad, NM 88220-4575 |
Second Address | Carlsbad, NM 88220-4575 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 05/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00009712 | (05) | NM |
9712 | (05) | NM |
C98073 | (02) | |
C98073 | (02) | NM |