Provider Demographics
NPI:1598315301
Name:RUBIO, JESSICA (QMHP-CS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:RUBIO
Suffix:
Gender:F
Credentials:QMHP-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6633 N MESA ST STE 103
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-4422
Mailing Address - Country:US
Mailing Address - Phone:915-307-4320
Mailing Address - Fax:
Practice Address - Street 1:6633 N MESA ST STE 103
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-4422
Practice Address - Country:US
Practice Address - Phone:915-307-4320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty