Provider Demographics
NPI:1912876665
Name:CARMONA, RUBEN
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:
Last Name:CARMONA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 W HANLEY AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8638
Mailing Address - Country:US
Mailing Address - Phone:208-765-0688
Mailing Address - Fax:
Practice Address - Street 1:1318 W HANLEY AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8638
Practice Address - Country:US
Practice Address - Phone:208-765-0688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-31
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator