Provider Demographics
NPI:1104011154
Name:EDMUNDO R. RUBIO MD INC.
Entity Type:Organization
Organization Name:EDMUNDO R. RUBIO MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMUNDO
Authorized Official - Middle Name:RICAFRENTE
Authorized Official - Last Name:RUBIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-531-3133
Mailing Address - Street 1:16660 PARAMOUNT BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5433
Mailing Address - Country:US
Mailing Address - Phone:562-531-3133
Mailing Address - Fax:562-531-3204
Practice Address - Street 1:16660 PARAMOUNT BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5433
Practice Address - Country:US
Practice Address - Phone:562-531-3133
Practice Address - Fax:562-531-3204
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDMUNDO R. RUBIO MD INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA306699OtherLICENSE
CAA84113Medicare UPIN