Provider Demographics
NPI:1114697067
Name:MUNGARRO-RUBIO, CANDY (FNP)
Entity Type:Individual
Prefix:
First Name:CANDY
Middle Name:
Last Name:MUNGARRO-RUBIO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S CORONADO DR STE 110
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-6352
Mailing Address - Country:US
Mailing Address - Phone:520-458-1787
Mailing Address - Fax:
Practice Address - Street 1:150 S CORONADO DR STE 110
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-6352
Practice Address - Country:US
Practice Address - Phone:520-458-1787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN137264163W00000X
AZ263479363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse