Provider Demographics
NPI:1437654688
Name:RUBIO, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:RUBIO
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 1:15427 AMBER MANOR LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044-1732
Mailing Address - Country:US
Mailing Address - Phone:281-650-8951
Mailing Address - Fax:
Practice Address - Street 1:15427 AMBER MANOR LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-1732
Practice Address - Country:US
Practice Address - Phone:281-650-8951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72367101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0Other0