Provider Demographics
NPI:1275036816
Name:RUBALCAVA, ELISABET
Entity Type:Individual
Prefix:
First Name:ELISABET
Middle Name:
Last Name:RUBALCAVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8233 REDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-8057
Mailing Address - Country:US
Mailing Address - Phone:909-552-3487
Mailing Address - Fax:
Practice Address - Street 1:8233 REDWOOD AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-8057
Practice Address - Country:US
Practice Address - Phone:909-552-3487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst