Provider Demographics
NPI:1083127518
Name:RUBALCAVA, ANGELA MARIA (MSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIA
Last Name:RUBALCAVA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 MURIETTA AVE
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2915
Mailing Address - Country:US
Mailing Address - Phone:818-987-3778
Mailing Address - Fax:
Practice Address - Street 1:5825 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4612
Practice Address - Country:US
Practice Address - Phone:323-933-9022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW595481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical