Provider Demographics
NPI:1699355313
Name:RUBIO, SAMANTHA LOBECK
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LOBECK
Last Name:RUBIO
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 1:165 NW 96TH TER APT 3-103
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6280
Mailing Address - Country:US
Mailing Address - Phone:786-442-4021
Mailing Address - Fax:
Practice Address - Street 1:15165 NW 77TH AVE STE 1002
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-7825
Practice Address - Country:US
Practice Address - Phone:786-442-4021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician