Provider Demographics
NPI:1548431018
Name:GUILLERMO RUBIANO DDS INC
Entity Type:Organization
Organization Name:GUILLERMO RUBIANO DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:RUBIANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-832-4916
Mailing Address - Street 1:844 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3604
Mailing Address - Country:US
Mailing Address - Phone:310-832-4916
Mailing Address - Fax:310-832-0754
Practice Address - Street 1:844 W 9TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3604
Practice Address - Country:US
Practice Address - Phone:310-832-4916
Practice Address - Fax:310-832-0754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA368281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty