Provider Demographics
NPI:1467065953
Name:CORONEL, RUBI ROJAS
Entity Type:Individual
Prefix:
First Name:RUBI
Middle Name:ROJAS
Last Name:CORONEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RUBI
Other - Middle Name:REBOLLAR
Other - Last Name:ROJAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6070 MISSION GORGE RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-4023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6070 MISSION GORGE RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-4023
Practice Address - Country:US
Practice Address - Phone:619-961-7734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health