Provider Demographics
NPI:1245424118
Name:RUBIO, SANDRA C (LPN)
Entity Type:Individual
Prefix:MISS
First Name:SANDRA
Middle Name:C
Last Name:RUBIO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 FENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-2112
Mailing Address - Country:US
Mailing Address - Phone:631-375-2433
Mailing Address - Fax:
Practice Address - Street 1:3 FENWOOD RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-2112
Practice Address - Country:US
Practice Address - Phone:631-375-2433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2582241164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse