Provider Demographics
NPI:1144610577
Name:RUBIO, MARIA IRENE (RPT)
Entity Type:Individual
Prefix:
First Name:MARIA IRENE
Middle Name:
Last Name:RUBIO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S BURNSIDE AVE APT 2B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-5438
Mailing Address - Country:US
Mailing Address - Phone:323-420-3810
Mailing Address - Fax:
Practice Address - Street 1:400 S BURNSIDE AVE APT 2B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-5438
Practice Address - Country:US
Practice Address - Phone:323-420-3810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29372282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital