Provider Demographics
NPI:1679854780
Name:RUBIO, EDGARDO C (DENTIST)
Entity Type:Individual
Prefix:DR
First Name:EDGARDO
Middle Name:C
Last Name:RUBIO
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2442 HILLTOP MALL RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-1928
Mailing Address - Country:US
Mailing Address - Phone:510-223-7955
Mailing Address - Fax:510-223-0249
Practice Address - Street 1:2442 HILLTOP MALL RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-1928
Practice Address - Country:US
Practice Address - Phone:510-223-7955
Practice Address - Fax:510-223-0249
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30978122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist