Provider Demographics
NPI:1760730899
Name:RUBALCAVA, JULISSA AMAYA
Entity Type:Individual
Prefix:MRS
First Name:JULISSA
Middle Name:AMAYA
Last Name:RUBALCAVA
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 1:6800 OWENSMOUTH AVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-3159
Mailing Address - Country:US
Mailing Address - Phone:818-610-6700
Mailing Address - Fax:818-347-7292
Practice Address - Street 1:6800 OWENSMOUTH AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-3159
Practice Address - Country:US
Practice Address - Phone:818-610-6700
Practice Address - Fax:818-347-7292
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health