Provider Demographics
NPI:1326303892
Name:RUBIO, WILFREDO V (MD)
Entity Type:Individual
Prefix:
First Name:WILFREDO
Middle Name:V
Last Name:RUBIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 KOZY CORNER RD.
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:PA
Mailing Address - Zip Code:16059-3416
Mailing Address - Country:US
Mailing Address - Phone:724-898-1413
Mailing Address - Fax:
Practice Address - Street 1:210 KOZY CORNER RD.
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:PA
Practice Address - Zip Code:16059-3416
Practice Address - Country:US
Practice Address - Phone:724-898-1413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD0348831L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice