Provider Demographics
NPI:1578347639
Name:RUBI DIXON, CHARLOTT REBECA
Entity Type:Individual
Prefix:
First Name:CHARLOTT
Middle Name:REBECA
Last Name:RUBI DIXON
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 1:1570 WRENTREE WAY
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-7050
Mailing Address - Country:US
Mailing Address - Phone:951-350-9750
Mailing Address - Fax:
Practice Address - Street 1:1570 WRENTREE WAY
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-7050
Practice Address - Country:US
Practice Address - Phone:951-350-9750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program