Provider Demographics
NPI:1992941595
Name:RUVALCABA, SANDRA (MA, BACB)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:RUVALCABA
Suffix:
Gender:F
Credentials:MA, BACB
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:RUVALCABA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, BACB
Mailing Address - Street 1:2760 FIELDSTONE RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-3100
Mailing Address - Country:US
Mailing Address - Phone:719-203-6903
Mailing Address - Fax:719-203-6904
Practice Address - Street 1:2760 FIELDSTONE RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-3100
Practice Address - Country:US
Practice Address - Phone:719-203-6903
Practice Address - Fax:719-203-6904
Is Sole Proprietor?:No
Enumeration Date:2009-01-02
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1084661174400000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist