Provider Demographics
NPI:1689838435
Name:RUBIO, ALISYN LORENZA
Entity Type:Individual
Prefix:MRS
First Name:ALISYN
Middle Name:LORENZA
Last Name:RUBIO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ALISYN
Other - Middle Name:LORENZA
Other - Last Name:PENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:673 ROYSTON LN APT 334
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-6774
Mailing Address - Country:US
Mailing Address - Phone:510-258-4168
Mailing Address - Fax:
Practice Address - Street 1:39217 LIBERTY ST
Practice Address - Street 2:SUITE B-10
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1501
Practice Address - Country:US
Practice Address - Phone:510-791-3322
Practice Address - Fax:510-791-3325
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health