Provider Demographics
NPI:1700406063
Name:RUBIO, JOSEPH (MA , EDS, LEP)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:RUBIO
Suffix:
Gender:M
Credentials:MA , EDS, LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13104 PHILADELPHIA ST STE 218
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-6315
Mailing Address - Country:US
Mailing Address - Phone:714-307-7213
Mailing Address - Fax:
Practice Address - Street 1:13104 PHILADELPHIA ST STE 218
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-6315
Practice Address - Country:US
Practice Address - Phone:714-307-7213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3531103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool