Provider Demographics
NPI:1134637499
Name:EDGARDO S RUBIO DMD CORP
Entity Type:Organization
Organization Name:EDGARDO S RUBIO DMD CORP
Other - Org Name:DR. EDGARDO S RUBIO DMD CORP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGARDO
Authorized Official - Middle Name:SANCHEZ
Authorized Official - Last Name:RUBIO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:510-730-3949
Mailing Address - Street 1:2442 HILLTOP MALL RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-1928
Mailing Address - Country:US
Mailing Address - Phone:510-730-3949
Mailing Address - Fax:
Practice Address - Street 1:4131 MACDONALD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805-2333
Practice Address - Country:US
Practice Address - Phone:510-730-3949
Practice Address - Fax:510-609-4946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61506261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental