Provider Demographics
NPI:1851957401
Name:RUBIO, ROMAN GABRIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMAN
Middle Name:GABRIEL
Last Name:RUBIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 ESTHER LN
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-2820
Mailing Address - Country:US
Mailing Address - Phone:650-438-7684
Mailing Address - Fax:
Practice Address - Street 1:722 ESTHER LN
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-2820
Practice Address - Country:US
Practice Address - Phone:650-438-7684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-18
Last Update Date:2019-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69946208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice