Provider Demographics
NPI:1235865494
Name:RUBIO, MAHYDA Y (ELECTROLOGIST)
Entity Type:Individual
Prefix:
First Name:MAHYDA
Middle Name:Y
Last Name:RUBIO
Suffix:
Gender:F
Credentials:ELECTROLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 W LA VETA AVE APT A
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2611
Mailing Address - Country:US
Mailing Address - Phone:714-251-7419
Mailing Address - Fax:
Practice Address - Street 1:630 S GLASSELL ST STE 203
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-3093
Practice Address - Country:US
Practice Address - Phone:714-251-7419
Practice Address - Fax:714-202-5511
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL8486156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty