Provider Demographics
NPI:1700862604
Name:RUBIO, CHERRI LYNN (LMNT, MS, RD, LD)
Entity Type:Individual
Prefix:MS
First Name:CHERRI
Middle Name:LYNN
Last Name:RUBIO
Suffix:
Gender:F
Credentials:LMNT, MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2546 E BITTERS RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-4448
Mailing Address - Country:US
Mailing Address - Phone:210-414-1648
Mailing Address - Fax:210-320-7013
Practice Address - Street 1:2546 E BITTERS RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-4448
Practice Address - Country:US
Practice Address - Phone:210-414-1648
Practice Address - Fax:210-320-7013
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT03757133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1737231Medicaid
TX7341615OtherAETNA
TX1737231Medicaid