Provider Demographics
NPI:1497880637
Name:RUBIO DAMIAN, BEATRIZ MARLENE (PA)
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:MARLENE
Last Name:RUBIO DAMIAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MARLENE
Other - Middle Name:
Other - Last Name:RUBIO DAMIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:5168 HONPIE RD
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-8682
Mailing Address - Country:US
Mailing Address - Phone:530-387-4975
Mailing Address - Fax:530-387-8006
Practice Address - Street 1:5168 HONPIE RD
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-8682
Practice Address - Country:US
Practice Address - Phone:530-387-4975
Practice Address - Fax:530-387-8006
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18716363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant