Provider Demographics
NPI:1417995804
Name:RUBIO HOLTZ, CHRISTINA KATHLEEN
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:KATHLEEN
Last Name:RUBIO HOLTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:CHRISTINA
Other - Middle Name:KATHLEEN
Other - Last Name:RUBIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 661748
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91066-1748
Mailing Address - Country:US
Mailing Address - Phone:626-447-0296
Mailing Address - Fax:626-447-6057
Practice Address - Street 1:5925 SAN VICENTE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-6630
Practice Address - Country:US
Practice Address - Phone:323-932-5105
Practice Address - Fax:323-932-5356
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89615207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A896150Medicaid
CAWA89615BMedicare PIN
CAI27276Medicare UPIN
CAWA89615Medicare PIN
CA00A896150Medicaid