Provider Demographics
NPI:1497512800
Name:RUBALCAVA, DIANA FABIOLA (PA-C)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:FABIOLA
Last Name:RUBALCAVA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3900 W COAST HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4093
Mailing Address - Country:US
Mailing Address - Phone:949-383-4185
Mailing Address - Fax:949-438-3828
Practice Address - Street 1:3900 W COAST HWY STE 300
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4093
Practice Address - Country:US
Practice Address - Phone:949-383-4185
Practice Address - Fax:949-438-3828
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant