Provider Demographics
NPI:1285834887
Name:CRUET-RUBIO, IRIS (MS)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:CRUET-RUBIO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 N CATALINA AVE UNIT 3052
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-8255
Mailing Address - Country:US
Mailing Address - Phone:310-819-1055
Mailing Address - Fax:310-943-0494
Practice Address - Street 1:879 W 190TH ST STE 400
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4223
Practice Address - Country:US
Practice Address - Phone:310-819-1055
Practice Address - Fax:310-943-0494
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist