Provider Demographics
NPI:1851051726
Name:RUBALCAVA, NOELLE RUTH (LEP)
Entity Type:Individual
Prefix:DR
First Name:NOELLE
Middle Name:RUTH
Last Name:RUBALCAVA
Suffix:
Gender:F
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 SAN DIEGO RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-2025
Mailing Address - Country:US
Mailing Address - Phone:510-910-3222
Mailing Address - Fax:
Practice Address - Street 1:765 SAN DIEGO RD
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707-2025
Practice Address - Country:US
Practice Address - Phone:510-910-3222
Practice Address - Fax:510-680-1189
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4016103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool