Provider Demographics
NPI:1376858928
Name:RUBIO, BERTA MARGARITA (MD)
Entity Type:Individual
Prefix:
First Name:BERTA
Middle Name:MARGARITA
Last Name:RUBIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 NEVADA ST
Mailing Address - Street 2:STE A
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4222
Mailing Address - Country:US
Mailing Address - Phone:909-307-8503
Mailing Address - Fax:
Practice Address - Street 1:12 NEVADA ST
Practice Address - Street 2:STE A
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4222
Practice Address - Country:US
Practice Address - Phone:909-307-8503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40576208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice