Provider Demographics
NPI:1164757415
Name:RUBIO, JOEL F I (CHANGE AGENT)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:F
Last Name:RUBIO
Suffix:I
Gender:M
Credentials:CHANGE AGENT
Other - Prefix:MR
Other - First Name:JOEL
Other - Middle Name:F
Other - Last Name:RUBIO
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:CHANGE AGENT
Mailing Address - Street 1:4343 WILLIAMSBOURGH DR
Mailing Address - Street 2:4343 WILLAMSBOURGH DRIVE
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2006
Mailing Address - Country:US
Mailing Address - Phone:916-395-3552
Mailing Address - Fax:916-395-3683
Practice Address - Street 1:4343 WILLIAMSBOURGH DR
Practice Address - Street 2:4343 WILLAMSBOURGH DRIVE
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2006
Practice Address - Country:US
Practice Address - Phone:916-395-3552
Practice Address - Fax:916-395-3683
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)